Prostate cancer is one of the more common tumors in the male population and represents about 15% of all cancers diagnosed in male patients. Estimates in 2012 report 36,300 new cases in Italy every year. According to the most recent data, in Italy one man out of 16, develops prostate cancer in the course of his lifetime. However, the risk for this disease having a bad outcome is not particularly high, especially if appropriate measures are taken in time. Survival 5 years after diagnosis is 70%: one of highest rates among tumors, especially taking into account the patients’ age and therefore other possible causes of death.
Prostate cancer develops very slowly and may show no symptoms for many years.
The number of prostate cancer diagnoses has gradually increased since the 1990s, when the prostate specific antigen (PSA) test was approved by the U.S. Food and Drug Administration (FDA). PSA values, however, are influenced by many factors and may be altered by the presence of a benign prostatic hyperplasia or of a local infection. For this reason, there’s been a recent tendency to consider the PSA trend more important, for purpose of diagnosis, than a single high measurement.
There are several types of cell in the prostate, each of which can transform itself and become cancerous. Almost all diagnosed prostate cancers, however, originate from gland cells and are called adenocarcinomas. In addition to adenocarcinomas, in rare cases also sarcomas, small cell carcinomas, and transitional cell carcinomas can be found in the prostate. Prostate cancer is classified based on grade, which indicates the aggressiveness of the disease, and stage, which instead indicates the extension of the disease. A biopsy can assess if the aspect of the tumor glands is similar and/or different from the normal ones. Based on the similarity or diversity, the Gleason grading system is assigned to the tumor. This is a score between 1 and 5 (the lowest score indicates that the cancer cells closely resemble normal cells).
The TNM system is instead used to stage the tumor. TNM measures the extent of the tumor (T), whether the cancer has spread to nearby lymph nodes (N), and the presence of metastases (M).
The correlation of these parameters (TNM, Gleason score, and PSA) identifies three classes of risk: low, intermediate, and high risk. Today many types of treatment are available for prostate cancer, each of which with benefits and specific side effects. Therapeutic approaches to prostate cancer span from close observation to active surveillance, from radiation therapy to surgery (radical prostatectomy), from hormone therapy to chemotherapy. The treatment of choice is based on specific factors such as tumor extent, extraprostatic extension, if any, patient’s age and general health status.
Radiation therapy plays a fundamental role in the treatment of prostate carcinoma in all stages, from initial ones to the locally advanced. Radiations can be provided as exclusive treatment or after surgery, in the presence of specific risk factors, or upon the onset of a biochemical relapse (progressive rise of PSA), or macroscopic local recurrence. These treatments are performed at UPMC Hillman Cancer Center at San Pietro FBF.
(Source: AIRC, 2016)
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