| Prostate Cancer |
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| Introduction
 Prostate cancer is the second leading cause of cancer deaths in men. (The first is lung cancer.) In 2004, approximately 230,000 prostate cancer cases were diagnosed in the U.S., of whom 29,900 patients died.
The frequency of both benign and malignant changes in the prostate increases with age. Autopsies of men in the eighth decade of life show malignant changes in over 70% of individuals.
PSA was approved for early detection in 1994. The normal range of PSA is 0 to 4 ng/mL. PSA values may fluctuate for no apparent reason, thus, an isolated abnormal value should be confirmed before proceeding with further testing. Rates of increase over .75 ng/mL per year suggest cancer.
A diagnosis of cancer is established by a TRUS-guided needle biopsy. MRI’s are often used to assess the extent of the cancer. In addition, radionuclide bone scans may be used to evaluate spread to bony sites.
Staging and Treatment
Localized prostate cancers are clinically confined to the prostate. Patients with localized disease are managed by radical surgery, radiation therapy, or watchful waiting. There is no clear evidence for the superiority of any one approach.
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TNM Stage |
Description |
Whitmore-
Jewett Stage |
Description |
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T1a |
Nonpalpable, with 5% or less of resected tissue with cancer |
A1 |
Well differentiated tumor |
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T1b |
Nonpalpable with >5% of resected tissue with cancer |
A2 |
Involvement more diffuse |
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T1c |
Nonpalpable, detected due to PSA |
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T2a |
Palpable, half of one lobe or less |
BIN |
Palpable, < one lobe, surrounded by normal tissue |
T2b |
Palpable, > half of one lobe but not both lobes |
B1 |
Palpable, < one lobes |
T2c |
Palpable, involves both lobes |
B2 |
Palpable, one entire lobe or both lobes |
T3a |
Palpable, unilateral extracapsular extension |
C1 |
Palpable, outside capsule, not into seminal vesicles |
T3b |
Palpable, bilateral extracapsular extension |
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Palpable, seminal vesicle involvement |
T3c |
Tumor invades seminal vesicle(s) |
C2 |
Palpable, seminal vesicle involved |
MI |
Distant metastases |
D |
Metastatic disease |
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The more advanced the disease, the lower the probability of local control and the higher the probability of systemic relapse. There are many prognostic models based on a combination of the initial T stage, Gleason score, and baseline PSA.
The Cancer Monthly database currently has the results
(survival, side effects, etc.) for 40 recent therapies for prostate cancer
including biological therapy, immunotherapy, chemotherapy, gene therapy,
hormone therapy, radiation therapy and alternative therapy.
Sign Up and See the Results Right Now
Source: Howard I. Scher, Hyperplastic and malignant Diseases of the Prostate, in Harrison’s Principles of Internal Medicine, pt. 5 § 81, at 543-549 (Dennis L. Kasper, M.D. et al., eds, 16th ed 2005).
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