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Upon completion of the chapter, the reader will be able to:
Identify risk factors associated with prostate cancer development.
Discuss the benefits and risks associated with prostate cancer screening.
Appraise the prognostic- and patient-specific data needed to determine appropriate treatment options.
Evaluate pharmacotherapeutic treatment options for patients with prostate cancer.
Formulate a monitoring plan for patients receiving androgen deprivation therapy for prostate cancer based on patient-specific factors and the prescribed regimen.
Recognize the common adverse effects associated with androgen deprivation therapy.
Evaluate appropriate pharmacotherapeutic treatment options for patients with metastatic castration-resistant prostate cancer.
Formulate a monitoring plan for patients receiving treatment for metastatic castration-resistant prostate cancer based on patient-specific factors and the prescribed regimen.
Recognize the common adverse effects associated with pharmacotherapeutic treatments for metastatic castration-resistant prostate cancer.
Prostate cancer is the most commonly diagnosed cancer in the United States in men, and is the second leading cause of cancer-related death in men.1 The disease course ranges from indolent, asymptomatic tumors that may not require treatment to rapidly progressing, aggressive tumors that result in distant metastases, morbidity, and mortality.
EPIDEMIOLOGY AND ETIOLOGY
Prostate cancer is the most frequently diagnosed cancer among men in the United States, and represents the second leading cause of cancer-related deaths in all men. In the United States alone, it is estimated that 164,690 new cases of prostate cancer will be diagnosed, and more than 29,430 deaths will occur in 2018.1 Although prostate cancer incidence increased during the late 1980s and early 1990s, due to widespread prostate-specific antigen (PSA) screening, prostate cancer-related deaths have declined since 1995.2
Prostate cancer risk factors include age, race/ethnicity, and family history of prostate cancer (Table 92–1).3 Age is the greatest predictor of risk, and while the disease is rare among men under age 40, the incidence sharply increases with each subsequent decade of life.2 An evaluation of autopsies from men who died of unrelated causes revealed prostate cancer in 2%, 29%, 32%, 55%, and 64% of men in their third, fourth, fifth, sixth, and eighth decades of life, respectively.4
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 |
|Germline mutations in one of 16 DNA repair genes (eg, BRCA1, BRCA2, ATM, and CHEK2) are associated with increased prostate cancer risk and severity |
|Possible Risk Factors |
|Environmental ||Clinical carcinoma incidence varies worldwide |
|Latent carcinoma ...|