Current Topic:
Management of early prostate cancer
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Abstract
Prostate cancer is the most common cancer in men in the UK accounting for 24% of all new male cancer diagnoses. Yet, prostate cancer contributes only 13% of the total male deaths from cancer in the UK. With 60% of prostate cancer being detected in men over the age of 70, the incidence of prostate cancer is likely to rise with a trend to increasing life expectancy. The advent of prostate specific antigen (PSA) screening has meant that the disease is being detected earlier in its course. Proponents of screening claim that this leads to a decreased mortality from the disease while opponents argue that many patients receive treatment with the attendant risks of morbidity when they had a clinically insignificant cancer. The main challenge in the care of prostate cancer patients is the discrimination of patients with clinically significant disease.
Once detected, prostate cancer does require a management strategy. Patients with early stage prostate cancer have a wide variety of management options available to them, ranging from active surveillance with selective delayed radical treatment to surgery, external beam radiotherapy or brachytherapy. The choice of treatment depends on many factors both specific to the disease and on the patient’s choice. The rationale behind these factors will be explored and palliative treatment options such as androgen deprivation and experimental options such as cryotherapy will also be touched upon.
The aim of this module is to understand the detection of the disease and the concept of prostate cancer staging. The controversial area of PSA screening will be explored, allowing the reader to form an opinion on its value. Internet resources will be introduced which allow the reader to gain practical skills in anatomic and radiologic prostate localisation. The different management strategies for early stage prostate cancer will be explored and, with the use of sample cases, the reader will gain an understanding of the treatment decisions faced by a prostate cancer patient and the multidisciplinary team that advises them.
