Prostate cancer

Prostate cancer is the most prevalent type of solid malignant tumour among men in UK. The incidence rate each year amongst age standardized males in the UK was 98.3/100,000. Increasing age is the strongest predeterminant for the development of prostate cancer. Virtually all prostate cancers are adenocarcinomas with their differentiation graded by means of the Gleason score. Since there are often no presenting symptoms, diagnosis is usually reliant on investigations such as digital rectal examination (DRE), the serum prostate-specific antigen (PSA) level, PCA3 m-RNA levels and biopsies guided by a trans-rectal ultrasound probe. Staging 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 potential cure. Side effects include erectile dysfunction and incontinence. Prostate cancer is also radio-sensitive and can be treated by external-beam radiotherapy or brachytherapy. Hormonal therapy, such as luteinizing-hormone-releasing hormone (LHRH) analogues and anti-androgens are used in locally advanced and metastatic disease. Patients may opt for prostate-specific antigen (PSA) surveillance allowing other therapeutic options to be employed if the PSA starts to rise or the tumour progresses locally. Cytotoxic chemotherapy is increasingly being used for hormone escaped/resistant prostate cancer, and other newer treatment options are in the pipeline. The survival rate for all stages of prostate cancer is now extending.