Upon completion of the chapter, the reader will be able to:
List the risk factors associated with the development of prostate cancer.
Discuss the benefits and risks associated with screening for prostate cancer.
Determine the prognostic- and patient-specific data needed to determine appropriate treatment options.
Recommend an initial treatment for prostate cancer on the basis of stage, Gleason score, prostate-specific antigen, patient age, and symptoms.
State adverse effects associated with androgen deprivation therapy.
List adverse effects associated with treatment options for castrate-resistant prostate cancer.
Determine an appropriate treatment for a patient with metastatic castrate-resistant prostate cancer.
Understand the role of immunotherapy in the treatment of metastatic castrate-resistant prostate cancer.
Prostate cancer is the most commonly diagnosed cancer in US men and the second leading cause of cancer-related death in men.1 The disease course varies from a slow growing, asymptomatic tumor that may not require treatment to a rapidly progressing, aggressive tumor resulting in distant metastasis, morbidity, and mortality.
EPIDEMIOLOGY AND ETIOLOGY
KEY CONCEPT Prostate cancer is the most frequently diagnosed cancer among US men and represents the second leading cause of cancer-related deaths in all men.1 In the United States alone, it was predicted that more than 280,000 new cases of prostatic cancer will be diagnosed and more than 27,000 men would die from this disease in 2015.1 Although prostate cancer incidence increased during the late 1980s and early 1990s, owing to widespread prostate-specific antigen (PSA) screening, deaths from prostate cancer have been declining since 1995.2 In the United States, 1 in 6 men will be diagnosed with prostate cancer, with 1 in 35 eventually succumbing to the disease.
The widely accepted risk factors for prostate cancer are age, race, and family history of prostate cancer (Table 92–1). Age is the greatest predictor of risk, the disease is rare under the age of 40, but the incidence sharply increases with each subsequent decade of life.2 In an evaluation of autopsies from men in Michigan dying of unrelated causes, prostate cancer was identified in 2%, 29%, 32%, 55%, and 64% of men in their third, fourth, fifth, sixth, and eighth decades of life, respectively.3 Men of older age have had a greater lifetime exposure to testosterone, a known growth signal for the prostate.
Table 92–1Risk Factors Associated with Prostate Cancer ||Download (.pdf) Table 92–1 Risk Factors Associated with Prostate Cancer
|Factor ||Possible Relationship |
|Probable Risk Factors |
|Age ||More than 70% of cases are diagnosed in men older than 65 years |
|Race ||African Americans have a higher incidence and death rate |
|Genetic ||Familial prostate cancer inherited in an autosomal dominant manner |
| ||Mutations in p53, Rb, E-cadherin, α-catenin, androgen receptor, KAI1, and microsatellite instability; loss of heterozygosity ...|