Chapter 84 William G. Nelson, H. Ballentine Carter, Theodore L. DeWeese, Emmanuel S. Antonarakis and Mario A. Eisenberger • Prostate cancer is the most commonly diagnosed life-threatening cancer in men (241,740 cases and 28,170 deaths in 2012). • Small prostate cancers are present in 29% of men between ages 30 and 40 and 64% of men between ages 60 and 70. • The lifetime risk of a prostate cancer diagnosis is 1 in 6, and the risk of dying from prostate cancer is 1 in 35. • Age, family history, diet and lifestyle, and ethnicity are risk factors for prostate cancer development. • Germline mutations in RNASEL and MSR1, encoding proteins that function in host responses to infection, appear responsible for some cases of hereditary prostate cancer. • An inflammatory lesion, termed proliferative inflammatory atrophy (PIA), is an early precursor to prostate cancer. • Somatic inactivation of GSTP1, encoding a carcinogen-detoxification enzyme, may initiate prostatic carcinogenesis by increasing the vulnerability of prostate cells to damage mediated by oxidant and electrophilic carcinogens. • Gene fusions, involving TMPRSS2 and ETS family transcription factor genes, may contribute to the androgen dependence of prostate cancers. • Defects in the functions of NKX3.1, PTEN, and CDKN1B are common in prostate cancer cells. • Prostate cancer screening using specific antigen (PSA) testing reduces the risk of prostate cancer death but may also lead to overdiagnosis of non-life-threatening disease. • Transrectal ultrasound (TRUS)-guided core needle biopsies are used to diagnose prostate cancer. • Stage, histologic grade (Gleason score), and serum PSA levels are prognostic factors. • Management options include observational strategies (watchful waiting and active surveillance), anatomic radical prostatectomy (with or without robot-assisted laparoscopic techniques), external beam radiation therapy, and brachytherapy. • A progressive rise in the serum PSA after treatment indicates prostate cancer recurrence. • Depending on the approach used, side effects associated with treatment of localized prostate cancer can include urinary, bowel, and sexual dysfunction. • Salvage therapy for prostate cancer recurrences after initial treatment include external radiation after surgery, or include surgery, brachytherapy, or cryosurgery after external beam radiation.
Prostate Cancer
Summary of Key Points
Incidence
Biological Characteristics
Screening, Diagnosis, and Staging
Primary Therapy
Prostate Cancer
