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Prostate carcinoma

Prostate carcinoma
in the Czech Republic

(click on the images to enlarge them)


Time trends in incidence and mortality.


Comparison of incidence in individual regions.


Age structure of patients.


Comparison of incidence in the Czech Republic and abroad.

(Source: www.svod.cz)

Incidence of the disease

Prostate carcinoma ranks among the most frequent cancer types in men, and its incidence shows a steady increase. Prostate cancer affects approximately 10% of men: in year 2000, 540.000 new cases were diagnosed worldwide. In 2003, 3813 new cases of prostate carcinoma were diagnosed in the Czech Republic (rough incidence: 76,6/100.000 persons), whereas 4846 new cases were diagnosed in 2005 (rough incidence: 96,6/100.000 persons)[1]. Similarly to other countries, the incidence of prostate carcinoma increases, while the mortality remains at the same level. The increase in incidence, particularly in the US, is due to the widespread use of screening tests (in the optimal case, combination of PSA test and digital rectal examination) and subsequent needle biopsy. This procedure reveals even latent forms of tumours, which would not be discovered otherwise. Another reason, particularly in the Scandinavian countries, is the development of prostate carcinoma in higher age groups, along with aging population. Prostate carcinoma is rare in men below 50 years of age; however, there is a significant growth in incidence in the seventh and eighth decades of life, and up to 80% of men older than 80 years are affected by prostate carcinoma. Early stages of this disease are revealed by the transurethral resection of the prostate (TURP) performed to treat benign hyperplasia of prostate, or by biopsy performed due to the elevated level of PSA (prostate specific antigen).

Diagnosis and treatment

Prostate carcinoma can be relatively successfully treated if it is detected early. Radical surgery can be performed at early stages, and patient’s survival is more or less the same as life expectancy of healthy individuals. Even advanced stages of prostate carcinoma do not shorten patients’ lives very significantly: many patients live with this diagnose 10 years and more without major difficulties.

Prostate carcinoma can be relatively easily diagnosed in later stages, when the disease is detected by rectal examination and confirmed by biopsy (removal of tissue for subsequent histological examination). A blood test to measure prostate specific antigen (PSA) in men over 50 years is the most effective test currently available for the early detection of prostate cancer: higher than normal level of PSA might be the first signal of prostate carcinoma. Many health care facilities have already made this test a routine procedure in physical examination of men over 50 years. It is in the interest of society that this simple examination is done on a routine basis, as it might help to detect prostate carcinoma at an early stage, when the disease can be effectively cured.

Apart from PSA level itself, several derived markers are used in prostate carcinoma diagnosis, such as age-specific PSA and PSA velocity.

The appropriate method of carcinoma prostate treatment depends not only on disease stage, but also on overall patient’s condition. Surgery is the basic method of choice, which can sometimes lead to a full recovery. However, surgery is only meaningful if carcinoma is detected at an early stage. Hormonal therapy is the most frequent method of choice in advanced stages of prostate carcinoma or in case of biochemical failure after surgery.

References

  1. Dušek L., Mužík J. Kubásek M., Koptíková J., Žaloudík J., Vyzula R.. Czech National Web Portal of Cancer Epidemiology [online]. Masaryk University [2005] . On-line available: http://www.svod.cz.
  2. Egevad LL, Allsbrook WCJ, Epstein JI. 2006. Current practice of diagnosis and reporting of prostatic intraepithelial neoplasia and glandular atypia among genitourinary pathologists. Mod Pathol 19(2):180-185.
  3. Epstein JI, Allsbrook WCJ, Amin MB, Egevad LL. 2006. Update on the Gleason grading system for prostate cancer: results of an international consensus conference of urologic pathologists. Adv Anat Pathol 13(1):57-59.
  4. Fine SW, Epstein JI. 2008. A contemporary study correlating prostate needle biopsy and radical prostatectomy Gleason score. J Urol 179(4):1335-1338.
  5. Lane Z, Epstein JI, Ayub S, Netto GJ. 2008. Prostatic adenocarcinoma in colorectal biopsy: clinical and pathologic features. Hum Pathol 39(4):543-549.