PROSTATE CANCER OVERVIEW

PROSTATE CANCER OVERVIEW

  • Prostate cancer is the most commonly diagnosed life-threatening cancer in men (241,740 cases and 28,170 deaths in 2012).
  • Small prostate cancers are present in 29% of men between ages 30 and 40 and 64% of men between ages 60 and 70.
  • The lifetime risk of a prostate cancer diagnosis is 1 in 6, and the risk of dying from prostate cancer is 1 in 35.
  • Age, family history, diet and lifestyle, and ethnicity are risk factors for prostate cancer development.
  • Germline mutations in RNASEL and MSR1 , encoding proteins that function in host responses to infection, appear responsible for some cases of hereditary prostate cancer.
  • An inflammatory lesion, termed proliferative inflammatory atrophy (PIA), is an early precursor to prostate cancer.
  • Somatic inactivation of GSTP1 , encoding a carcinogen-detoxification enzyme, may initiate prostatic carcinogenesis by increasing the vulnerability of prostate cells to damage mediated by oxidant and electrophilic carcinogens.
  • Gene fusions, involving TMPRSS2 and ETS family transcription factor genes, may contribute to the androgen dependence of prostate cancers.
  • Defects in the functions of NKX3.1, PTEN, and CDKN1B are common in prostate cancer cells.
  • Prostate cancer screening using specific antigen (PSA) testing reduces the risk of prostate cancer death but may also lead to overdiagnosis of non-life-threatening disease.
  • Transrectal ultrasound (TRUS)-guided core needle biopsies are used to diagnose prostate cancer.
  • Stage, histologic grade (Gleason score), and serum PSA levels are prognostic factors.
  • Management options include observational strategies (watchful waiting and active surveillance), anatomic radical prostatectomy (with or without robot-assisted laparoscopic techniques), external beam radiation therapy, and brachytherapy.
  • A progressive rise in the serum PSA after treatment indicates prostate cancer recurrence.
  • Depending on the approach used, side effects associated with treatment of localized prostate cancer can include urinary, bowel, and sexual dysfunction.
  • Salvage therapy for prostate cancer recurrences after initial treatment include external radiation after surgery, or include surgery, brachytherapy, or cryosurgery after external beam radiation.
  • Adjuvant androgen suppression can improve survival for some men with prostate cancer treated with external beam radiation therapy.
  • Adjuvant external radiation improves survival for some men treated with radical prostatectomy.
  • Androgen suppression, most often accomplished via the use of luteinizing hormone–releasing hormone (LHRH) analogs or antagonists, with or without antiandrogens, is the most commonly used treatment.
  • Side effects can include loss of libido, hot flashes, gynecomastia, loss of lean muscle mass and bone density, and the development of metabolic syndrome.
  • Docetaxel and cabazitaxel chemotherapy improves the survival of men with progressive androgen-independent prostate cancer.
  • Second-line treatments targeting the androgen-signalling pathway, including abiraterone acetate and enzalutamide, prolong survival of men previously treated with androgen suppression and taxane chemotherapy.
  • Bisphosphonates and denosumab antagonize loss of bone density accompanying androgen deprivation, and reduce skeletal complications associated with metastatic prostate cancer progression.
  • Sipuleucel-T, a dendritic cell vaccine, has shown a survival benefit in men with advanced prostate cancer. Other immunotherapies are under development in clinical trials.

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Genomic Medicine UK is the home of comprehensive genomic testing in London. Our consultant medical doctors work tirelessly to provide the highest standards of medical laboratory testing for personalised medical treatments, genomic risk assessments for common diseases and genomic risk assessment for cancers at an affordable cost for everybody. We use state-of-the-art modern technologies of next-generation sequencing and DNA chip microarray to provide all of our patients and partner doctors with a reliable, evidence-based, thorough and valuable medical service.

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