Resumen de Prostate cancer
Anita Lavery, Roger Kirby, Simon Chowdhury
Prostate cancer is a major health problem. In the UK, it is the commonest male cancer and the second commonest cause of male cancer death. Increasing age is its strongest predeterminant. Virtually all cancers are adenocarcinomas, the grade being indicated by the Gleason score. There are often no presenting symptoms. Investigations such as serum prostate-specific antigen, digital rectal examination, biopsy and, increasingly, magnetic resonance imaging (MRI) are required for diagnosis. Local staging consists of MRI, with computed tomography, bone scanning and, increasingly, positron emission tomography for detecting metastases. Management depends on disease stage, the patient's fitness and their wishes regarding treatment. Active surveillance is increasingly used for low-volume and low-grade cancers. For localized prostate cancer, radical prostatectomy can offer a cure. Curative treatment can be given as external-beam radiotherapy or brachytherapy. The survival rate at 10 years may be as high as 90% for a well-differentiated, localized prostate cancer. Hormonal therapy, which lowers or blocks testosterone, is used in locally advanced and metastatic disease. Hormonal therapy slows but does not cure metastatic disease. Cytotoxic chemotherapy is increasingly used for castrate-refractory prostate cancer and has recently been shown to significantly improve overall survival in hormone-naive patients with metastatic prostate cancer.
