Cancer of the prostate gland

Prostate cancer constitutes a major health problem. It is estimated that the lifetime risk of western men having prostate cancer is about 30%, with the risk of dying from the cancer being 3%. Increasing age is the strongest pre-determinant for the development of prostate cancer. Virtually all cancers are adenocarcinomas, the grade being indicated by the Gleason score. Often, there are no presenting symptoms. Investigations such as serum prostate-specific antigen (PSA), digital rectal examination and biopsies via a transrectal ultrasound probe are required for diagnosis. Staging, if required, consists of magnetic resonance imaging or computed tomography for locally advanced disease and/or a bone scan for detection of bony metastases. Management depends largely on the stage of the disease. For localized prostate cancer, radical prostatectomy can offer a cure. Adverse consequences include erectile dysfunction and incontinence. Prostate cancer is also radiosensitive and treatment can be given as external-beam radiotherapy or in the form of brachytherapy. Hormonal therapy, such as luteinizing hormone-releasing hormone analogues and anti-androgens, is used in locally advanced and metastatic disease. Hormones do not cure but slow the progression of the cancer. Follow-up consists of PSA surveillance and other therapeutic options can be considered if the PSA starts to rise. Cytotoxic chemotherapy is increasingly being used for hormone-escaped prostate cancer. The survival rate at 10 years may be as high as 90% for a well-differentiated, localized prostate cancer.