[Adenocarcinoma of the prostate]

Cancer of the prostate is an heterogenic, "epidemic" world-wide tumor, which represents the most common form of solid cancer in adult males, excluding nonmelanoma skin cancer. Prostate cancer now surpasses the incidence of lung cancer and becomes the second leading cause of male cancer death in the industrialized West countries. The incidence and mortality of prostate cancer are increasing to alarming rates (in the USA carcinoma prostate was projected to be responsible for 14% of all male cancer deaths in 1996). As the life expectancy of the male population increases over time, the incidence of clinical prostate cancer will also increase. There is a wide geographic variation in the incidence of clinical prostate cancer, with higher rates in the United States than in China. A difference in diagnostic practice with regard to prostate cancer can be the explanation for this wide divergence. One risk factor which could explain this fact is the high fat Western diet. It is also apparent that prostate cancer is now being detected at less advanced stages than in the past. It has become evident that there is a greater than expected incidence of this tumor in the male relatives of men who died from the disease. Hereditary prostate cancer is characterized by Mendelian autosomal dominant inheritance, and an early onset of the disease. Prostate specific antigen (PSA) represents the best serum marker for prostatic carcinoma and is considered as most perfect tumor marker available today. Nevertheless, the use of PSA to detect prostate cancer is clinically imprecise since benign and malignant prostate disease can cause elevations in PSA. The biological behaviour and the natural course of prostate cancer are poorly understood. There are far larger numbers of males who have a so-called latent, well-differentiated microscopic (clinically insignificant) prostate carcinoma that may never progress to invasive clinical disease with metastatic potential. These incidental cancers discovered histologically after the transurethral or open prostatectomy and as a result of the prostate biopsy in patients with the high level of PSA are currently not well understood. Results of the mass screening for prostate cancer are at present controversial and their benefit is still not confirmed. There is now strong evidence for the screening of first degree male relatives of men with prostate cancer, particularly male relatives of those developing the disease at a young age and those with a strong positive family history of the disease. There is no debate that the earlier diagnosis of prostate carcinoma, especially in young men give them the best chance to be cured. The "watchful waiting" seems the best treatment strategy for older men with so called insignificant carcinoma. The aggressive modalities of the therapy--radical prostatectomy, radiation therapy, interstitial brachy-therapy or interstitial cryotherapy--are the curable methods only for organ-confirmed tumors and advocated in patients with life expectancy longer than 10 years. Androgen ablation therapy is the treatment of choice for the palliation of patients with advanced prostate cancer. Maximal androgen ablation (combination of medical or surgical castration and an antiandrogen) has been shown to increase the survival of patients with metastatic prostate cancer. As the incidence and prevalence of prostate cancer have increased, so has mortality, though at a slower rate. This fact may more a reflection of earlier diagnosis rather than improvements in treatment. Five-year prostate cancer survival has improved for every stages of disease in the last decenium. Thanks to the screening programmes performed in many countries, urologists are faced with an increasing incidence of clinical less advanced prostate cancer and this trend is likely to continue. (ABSTRACT TRUNCATED)