Cancer of the prostate
Section snippets
Incidence and mortality
Carcinoma of the prostate is the most frequent cancer among men in northern and western Europe. About 190,000 new cases occur each year (15% of all cancers in men) [1]. In Europe, the annual incidence rates (ASW) in 2000 ranged between 19 (eastern Europe) and 55 (western Europe) per 100,000. In most European countries, the incidence has increased more than any other cancer over the past two decades [2]; it has been increasing by about 10% every 5 years in Europe (more in Sweden and France), as
Presentation
About 70–75% of prostate cancers arise in the peripheral zone of the gland, mainly in a posterior location, of the remaining cases, 15% derive from the central zone and 10–15% from the transitional zone. A high-grade prostatic intraepithelial neoplasia (HGPIN) may be associated with or precede cancer in a high percentage of cases [19].
Tumour growth
Prostate adenocarcinoma may spread locally, by direct invasion of seminal vesicles, urinary bladder or surrounding tissues or distantly. Distant metastases can
Symptoms
Low urinary tract symptoms (LUTS) can be present in organ-confined tumors but are usually due to concomitant benign prostatic hyperplasia (BPH). Locally advanced disease, however, is more likely to have an increase in LUTS due both to BPH and carcinoma. In the case of metastatic prostate cancer patients may present with lumbar or pelvic pain as the predominant symptom.
Physical signs
A diagnosis of prostate cancer may be suspected from symptoms, a suspicious digital rectal examination (DRE) finding and/or an
Stage classification
Two systems are usually employed in the staging of prostate cancer: the “Jewett System” (stages A–D) introduced in 1975 [64] and a revised TNM System proposed by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) which includes some subcategories in the same T categories of the Jewett System. The TNM System is more precise in stratifying newly diagnosed patients [65].
General consideration
Prostate cancer is characterized by an extremely high histological prevalence and a relatively low mortality. The 5-year observed survival of men with prostate cancer has increased steadily from 45% for men newly diagnosed in 1973 to 70% for men newly diagnosed in 1990, whereas the 10-year observed survival has increased by about 0.9 per year from 22% for men newly diagnosed in 1973 to 32% for men newly diagnosed in 1985. These data, however, derive from a substantial stage migration caused
General considerations
Treatment strategy is defined according to initial PSA, stage and grade of the disease and to the age and general conditions of the patient. Watchful waiting (WW), surgery and radiotherapy (with or without hormone-therapy) could be appropriate choices for patients with localized disease, while hormone-therapy plus radiotherapy should be considered treatment of choice for locally advanced or bulky disease. In cases of advanced disease, ablative hormone-therapy remains the mainstay of treatment
Late sequelae related to surgery
When making treatment choices in early prostate cancer, patients must weigh the benefits against adverse events such as incontinence and impotence that may affect quality of life (QoL) [170], [171].
Follow-up after curative treatments
Patients who underwent potentially curative treatments such as radical prostatectomy or radical radiotherapy are at risk of relapse. Incidence, site and timing of relapse depend of Gleason score, baseline PSA and clinical or pathological stage. Patients have to be followed at 3–4 monthly intervals with PSA, haemato-biochemistry and digital rectal exploration during the first year, every 6 months for the following 2 years and then yearly. Trans-rectal ultrasound, bone scintigraphy and other
Sergio Bracarda is specialist in medical oncology and urology and senior assistant of the Medical Oncology Division, Ospedale Silvestrini, Azienda Ospedaliera di Perugia.
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Cited by (0)
Sergio Bracarda is specialist in medical oncology and urology and senior assistant of the Medical Oncology Division, Ospedale Silvestrini, Azienda Ospedaliera di Perugia.
Ottavio de Cobelli is director of Urology Department at the European Institute of Oncology, Milan, Italy.
Carlo Greco is associate professor of Radiation Oncology at the University of Magna Graecia, Catanzaro, Italy.
Tommaso Prayer-Galetti is staff urologist at the Department of Urology, Padua University (Italy) and professor at the Residency Training Program in Urology. For 20 years he has been involved in a number of experimental and clinical projects on prostate oncology.
Riccardo Valdagni is head of the prostate programme at Istituto Nazionale Tumori, Milan, Italy. He is involved in projects on experimental, clinical and psycho oncology.
Gemma Gatta is assistant researcher in the Unit of Epidemiology of Istituto Nazionale Tumori, Milan, Italy. She is involved in projects with population based cancer registries on incidence, survival and prevalence.
Filippo de Braud is clinical editor of START. He is director of clinical pharmacology and new drugs development unit at the European Institute of Oncology, Milan, Italy.
Georg Bartsch is professor and chairman of the Department of Urology, Medical University of Innsbruck, Austria.