[Pathology and epidemiology of prostatic cancer]

Cancer of the prostate is a tumor of older men (average age 71 years). Since 1975, in the Federal Republic of Germany the mortality rate of prostatic cancer has not further increased in men over 50 years of age. Its letality rate averages 50%. Since the introduction of the early cancer detection program for men in 1971, carcinomas of the prostate are identified at an yearly increasing rate. In more than 50% of men over the age of 80 latent cancer of the prostate is present. Early prostatic carcinoma primarily spreads intraprostatically and will usually not metastasize after having extended beyond the capsule of the organ. Following lymphatic spread to the regional pelvic lymph nodes, osseous metastases will occur (lumbar vertebral column and pelvic bone) through blood circulation. Only in a late stage lungs and liver will be involved. Cancer of the prostate is staged according to the TNM system. Microscopical diagnosis of prostatic carcinoma is today possible with the same diagnostic accuracy histologically as well as cytologically. The transrectal aspiration biopsy procedure for the cytological diagnosis is followed by nearly no complications and is less distressing for the patient than the punch biopsy. A prognostically valid grading of tumor malignancy is possible by histological as well as by cytological investigation. The prognosis of treated grade I patients is not reduced in comparison to that of healthy males of the same age. Precancerous lesions in the prostate have not yet been ascertained. The effectiveness of radio-therapy applied to prostatic cancer can histologically and cytologically be controlled at the earliest 1 year after discontinuation of therapy