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Key Points

  • Disease summary:

    • Prostate cancer is the second most fatal cancer for American men. It is the most common male noncutaneous cancer in developing countries, and a leading cause of death for men 60 years or older.

    • Age, African ancestry, and a positive family history are risk factors for disease development (Table 48-1).

    • Recent evidence suggests that approximately 10% of prostate cancers are hereditary.

    • Adenocarcinoma, cancer of glandular epithelial cells, is the most commonly diagnosed form.

    • Early diagnosis significantly improves treatment response and overall survival and is based on both biochemical studies using prostate-specific antigen (PSA) levels in patients and subsequent biopsies with Gleason scoring.

    • Treatment modalities for prostate cancer include hormone-based approaches, radiation, cytotoxic chemotherapy, and radical prostatectomy. Despite proper treatment many prostate cancer patients experience recurrence and will eventually develop aggressive metastatic prostate cancer, even when presenting initially with localized or indolent disease. No consistent biomarkers yet exist to distinguish between indolent and aggressive forms. Prostate cancer’s genetic heterogeneity and complexity have hindered the elucidation and exploitation of the pathways driving pathogenesis and disease progression.

Table 48-1Risk Factors Associated With Prostate Cancer

  • Hereditary basis:

    • While age, race, and family history are known risk factors for prostate cancer, our understanding of the genetic basis of disease remains unclear. Germline mutations, often inherited in an autosomal dominant manner, may account for 9% of all prostate cancers and 45% of cases in men younger than 55 years. Linkage-based studies, positional gene cloning, and genome-wide association studies (GWAS) have been attempted and ...

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