Prostate Cancer

Cancer Monthly > Cancer Basics > Prostate Cancer

The Cancer Monthly database currently has the results (survival, side effects, and more) for 40 recent therapies for prostate cancer including biological therapy, immunotherapy, chemotherapy, gene therapy, hormone therapy, radiation therapy and alternative therapy.

Introduction

Prostate CancerProstate 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.

TNM Stage Description Whitmore-Jewett Stage Description
T1a Nonpalpable, with 5% or less of resected tissue with cancer A1 Well differentiated tumor
T1b Nonpalpable with >5% of resected tissue with cancer A2 Involvement more diffuse
T1c Nonpalpable, detected due to PSA
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 Palpable, seminal vesicle involvement
T3c Tumor invades seminal vesicle(s) C2 Palpable, seminal vesicle involved
MI Distant metastases D Metastatic disease

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.

 

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).