Prostate Cancer
William G. Nelson, H. Ballentine Carter, Theodore L. DeWeese, Emmanuel S. Antonarakis and Mario A. Eisenberger
Summary of Key Points
Incidence
• 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.
Biological Characteristics
• 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.
Screening, Diagnosis, and Staging
• 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.
Primary Therapy
• 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.
