Written by epgonline.org - Last updated 29 May 2018

Prostate cancer is one of the most commonly diagnosed cancer in males globally. It is a highly heterogeneous condition; it can be aggressive but will more typically develop slowly, and the majority of patients with prostate cancer will not die as a direct result of it.

Incidence increases with age and is higher in certain ethnic groups. Modifiable risk factors have been difficult to establish clearly – although some studies have suggested a link between sexually transmitted infections (particularly gonorrhoea) and prostate cancer.

Early symptoms of localised prostate cancer often relate to the local mass effect – poor urinary flow, recurrent infections and nocturia, as well as haematuria, pelvic and back pain.

Since the advent of prostate-specific antigen (PSA) testing, incidence has risen significantly – reflecting increased detection. There is debate surrounding the benefits of PSA testing, as screening using PSA does detect more malignancies, but does not reduce mortality. Autopsy studies have demonstrated that over the age of 50, a significant proportion (up to 30%) of men will have histologically-detectable prostate cancer; the majority of which will not go on to develop clinically significant disease.

Treatment options for prostate cancer have developed rapidly and continue to evolve. Minimally invasive, localised treatment options for ablation are undergoing early trials at the time of writing. Surgical options for prostatectomy have traditionally been subject to a high proportion of side-effects leading to sexual dysfunction: impotence and orgasmic dysfunction are common side-effects of damage to surrounding nerves, and are often unavoidable. Robot-assisted prostatectomy is another option offered in some centres, which offers advantages and disadvantages over open surgery. Transurethral resection of the prostate is an option for controlling localised urinary symptoms.

Surgical treatments are often unnecessary, and localised disease can be managed conservatively with active surveillance in some patient groups. Serial PSA measurement is particularly useful in this setting. Anti-androgen treatments and radiation therapy are other mainstays of management for prostate cancers.

Yin M, Bastacky S, Chandran U, Becich MJ, Dhir R. Prevalence of incidental prostate cancer in the general population: a study of healthy organ donors. J Urol. 2008;179:892–5.
Caini S, Gandini S, Dudas M, Bremer V, Severi E, Gherasim A. Sexually transmitted infections and prostate cancer risk: A systematic review and meta-analysis. Cancer Epidemiol 2014;38:329–38.

 

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