The introduction of an effective blood test, prostate specific antigen (PSA), has made it possible to diagnose more and more men in an earlier stage where they can be offered potentially curative treatments. The other side of the coin is that if effective diagnostic procedures are used unselectively in elderly men with a short life expectancy, a problem with over diagnosis and over treatment might occur. Thus the same stage of prostate cancer may need different treatment strategies, pending on the patient’s life expectancy. This, and many other issues regarding the disease, is the subject of the EAU guidelines on prostate cancer. G UI DE LI N ES O N P RO ST AT E CA N CE R 10

/pdf/guidelines-on-prostate-cancer-xdnunn4th8.pdf

Guidelines on Prostate Cancer

Background The selection of treatment for patients with localized prostate cancer requires reliable information about the outcome of conservative management. Previous studies of this question are generally considered unreliable because they were uncontrolled and nonrandomized. Methods We performed a pooled analysis of 828 case records from six nonrandomized studies, published since 1985, of men treated conservatively (with observation and delayed hormone therapy but no radical surgery or irradiation) for clinically localized prostate cancer. A Cox regression analysis was performed to determine which factors influenced survival among patients who did not die of causes other than prostate cancer (disease-specific survival). Kaplan-Meier curves for overall and metastasis-free survival among such patients were compared with use of the log-rank method and the Mantel-Haenszel test. Results Factors that had a significant effect on disease-specific survival were grade 3 tumors (risk ratio, 10.04), residence in Is...

Results of Conservative Management of Clinically Localized Prostate Cancer

Long-Term (15 Years) Results After Radical Prostatectomy For Clinically Localized (Stage T2c Or Lower) Prostate Cancer

Early detection of prostate cancer.

Decreased levels of the cell-cell adhesion molecule E-cadherin are associated with loss of differentiation in a number of human carcinomas. However, the value of E-cadherin as a prognostic marker in these cancers is largely undetermined. A previous study of E-cadherin levels in prostate cancer revealed that almost 50% of tumors examined had reduced or absent levels of this protein (Umbas et al. , Cancer Res., 52: 5104–5109, 1992). To determine the potential prognostic significance of this finding, prostate cancer specimens from 89 patients were evaluated immunohistochemically for E-cadherin expression, and the results were related to histopathological grade, tumor stage, presence of metastases, and survival. As previously observed, a significant inverse correlation was found between E-cadherin expression and tumor grade. Importantly, we also found significant correlations between E-cadherin expression and tumor stage and overall survival. Sixty-three percent of the tumors that extended beyond the prostate capsule (T 3–4 ) versus 33% of the tumors confined to the prostate (T 1–2 ) had aberrant expression (χ 2 = 8.1, P 2 = 14.9; P 2 = 20.4, P P

https://cancerres.aacrjournals.org/content/canres/54/14/3929.full.pdf

Decreased E-Cadherin Expression Is Associated with Poor Prognosis in Patients with Prostate Cancer

A series of 122 patients with a cytological diagnosis of well or moderately differentiated and clinically localised (T1-2) prostatic carcinoma were followed up without any initial anti-tumour therapy. The median observation time was 91 months. During follow-up the local tumour progressed to stage T3 in 67 patients (55%) and distant metastases developed in 17 (14%), 47 patients died (38%), 9 of them (7%) from prostatic carcinoma. The risk of dying from prostatic carcinoma was 1% after 5 years and 16% after 10 years for patients not dying from other causes

Deferred treatment in clinically localised prostatic carcinoma.

The Prognostic Value of Modal Deoxyribonucleic Acid in Low Grade, Low Stage Untreated Prostate Cancer

Deferred Treatment of Clinically Localized Low Grade Prostate Cancer: The Experience From A Prospective Series at The Karolinska Hospital

Summary— A surveillance study was carried out on 167 patients with low grade, low stage prostatic carcinoma without known metastases; of these, 146 were evaluated, the mean follow-up time being 50 months. Local tumour progression occurred in 77 patients (53%), corresponding to a 5-year cumulative probability of progression of 67%. Ten patients developed metastases, 5 died of prostatic carcinoma and 24 died of other causes. Cox's regression analysis showed that the initial cytological grade of the tumour was of prognostic importance, but initial local tumour stage, prostatic acid phosphatase activity and age had no statistically significant prognostic value. Although the number of patients developing metastases and dying of prostatic carcinoma was low, most tumours seemed to progress locally.

Torsten Löwhagen

Papers

Deferred treatment in clinically localised prostatic carcinoma.

The Prognostic Value of Modal Deoxyribonucleic Acid in Low Grade, Low Stage Untreated Prostate Cancer

Deferred Treatment of Clinically Localized Low Grade Prostate Cancer: The Experience From A Prospective Series at The Karolinska Hospital

The natural course of low grade, non-metastatic prostatic carcinoma.