Early detection of prostate cancer

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Prostate cancer characterization traditionally relies on volume, grade, and invasiveness.
• Autopsy and clinical studies indicate large, poorly differentiated, or invasive prostate cancers are lethal if untreated.
• The existence of two forms of prostate cancer is unsupported; initial transformation is similar, requiring a promoter for malignant potential.

Purpose of the Study:

• To review traditional criteria for characterizing prostate cancer biology.
• To explore the distinction between potentially lethal and latent small prostate cancers.
• To support the concept of a multistep process in prostate cancer pathogenesis.

Main Methods:

• Review of autopsy and clinical studies on prostate cancer pathology and natural history.
• Analysis of treatment trial results.
• Examination of volumetric studies and their correlation with clinical outcomes.

Main Results:

• Large prostate cancers, especially those poorly differentiated or invasive, are definitively dangerous.
• Approximately 20% of "autopsy" prostate cancers are large enough to be clinically significant but undetected.
• Lifetime risk analysis for a 50-year-old man shows a 42% risk of developing prostate cancer, 9.5% clinical disease risk, and 2.9% mortality risk.

Conclusions:

• Every large prostate cancer is considered dangerous.
• Further research into nuclear features, DNA content, and oncogene expression is needed to differentiate dangerous small prostate cancers from latent ones.
• The concept of a multistep process in prostate cancer pathogenesis is strongly supported by correlations between autopsy findings and global incidence/mortality rates.