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Recent Advances in Prostate Cancer: What the Patients needs to know 2008
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Recent Advances in Prostate Cancer:Recent Advances in Prostate Cancer:What the Patients needs to know 2008What the Patients needs to know 2008
Per-Anders AbrahamssonDepartment of Urology
Malmö University HospitalMalmö, Sweden
Europa Uomo, Milan, March 29,2008
Prostate Cancer: the 1980s
• PSA:
• Anatomical Radical prostatectomy
Stamey et al, NEJM 1987; Walsh et al, Prostate 1983
Bill-Axelson A, et al. N Engl J Med. 2005;352:1977-84.
SPCG-4: Mortality
Years to follow-up
Cum
ula
tive
inci
dence
of
death
fro
m
pro
state
ca
nce
r (%
)
0
10
20
30
40
0 2 4 6 8 10
Watchful waiting < 65 yearsRadical prostatectomy < 65 years Radical prostatectomy ≥ 65 yearsWatchful waiting ≥ 65 years
No. at riskRadical prostatectomy 347 343 332 284 210 118Watchful waiting 348 341 326 279 198 104
010203040
0 2 4 6 8 10
Radical prostatectomyWatchful waiting
Cum
ula
tive
inci
dence
of
death
fro
m
pro
state
ca
nce
r (%
)
Years to follow-up
p = 0.01RR = 0.56
Prostate Cancer: the 1990s
• Radical prostatectomy – Curative surgical ‘gold standard’
• Watchful waiting– Men with less than 10 years life expectancy
– Men with co-morbidities
Prostate-Specific AntigenProstate-Specific Antigen
• Best cancer marker ever discovered
• Used for:– Detection and screening– Prognosis & – Monitoring of prostate cancer
Reality of PSA TestingReality of PSA Testing
HEALTHY & BENIGN DISEASE
PROSTATE CANCER
CUT OFF
70%FALSE POS.
PSANg/mL0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 100.0
20%FALSE NEG.