The most common cancer in men with in England and Wales producing second highest number of deaths of male cancer, causing 13% of all cancer deaths in men.
- Local disease is almost always diagnosed incidentally as a result of a presentation with prostatism
- Metastatic disease is often diagnosed late and classically is manifest by bony spread
- PSA screening without symptoms is a controversial area and international practice may vary. The main point is that early diagnosis by this means may not influence net morbidity or mortality.
Graded according to the Gleason grade.
There is a variation in the incidence of prostatic cancer between races. As a hormone sensitive cancer, one hypothesis is that the length of a CAG trinucleotide repeat may affect androgen receptor expression with shorter repeats showing a higher risk of cancer. A meta-analysis of this confirmed a small difference of only about 1 repeat and concluded that this is unlikely to have biological significance.
There are additional associations with the pathways of androgen metabolism and growth factor expression. These include polymorphisms and mutations of the CYP17A1, CYP3A4, CYP19A1, SRD5A2, IGF1, and IGFBP3 genes.
- Local disease may be very good
The Cancer research UK site gives prognostic and other information. Prognosis is easily confounded by easily confounded by lead time bias and this can lead to ill informed assumptions based on analogy with other cancers without such bias.
Staging of disease in those where treatment decisions may alter, is a combination of isotope bone scan and prostate MRI. The order of investigation varies, but often bone scan generally first as metastatic disease would alter the requirement for local staging in most centres.
- Hormone manipulation
- Chemotherapy and radiotherapy
In metastatic castration-resistant prostate cancer a number of options:
- Docetaxel standard first-line treatment in patients with castration-resistant prostate cancer
- Cabazitaxel (XRP6258)-prednisone treatment superior survival time than mitoxantrone-prednisone
- Sipuleucel-T cell-based immunotherapy produces longer survival times in chemotherapy-naive patients
- Abiraterone acetate increases survival times after docetaxel
- MDV3100 an androgen receptor signaling inhibitor increases survival after docetaxel
- Zoledronic acid does not improve survival but reduces skeletal related events. Sodium clodronate may improve survival.
- ↑ a b Prostate cancer: diagnosis and treatment CG175 NICE 2014
- ↑ Zeegers MP, Kiemeney LA, Nieder AM, Ostrer H. How strong is the association between CAG and GGN repeat length polymorphisms in the androgen receptor gene and prostate cancer risk? Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2004 Nov; 13(11 Pt 1):1765-71.
- ↑ Hatcher D, Daniels G, Osman I, Lee P. Molecular mechanisms involving prostate cancer racial disparity. American journal of translational research. 2009; 1(3):235-48.(Epub)
- ↑ http://www.cancerhelp.org.uk/help/default.asp?page=3505
- ↑ Sartor O, Michels RM, Massard C, de Bono JS. Novel therapeutic strategies for metastatic prostate cancer in the post-docetaxel setting. The oncologist. 2011; 16(11):1487-97.(Link to article – subscription may be required.)
- ↑ Mukherji D, Pezaro CJ, De-Bono JS. MDV3100 for the treatment of prostate cancer. Expert opinion on investigational drugs. 2012 Feb; 21(2):227-33.(Link to article – subscription may be required.)