Karcinom prostaty s novou tváří*

New Aspects in Prostate Cancer Therapy

Prostate cancer remains the most common noncutaneous human malignancy, and the second most lethal tumour among men. The clinical presentation of this tumour has recently completely changed, which is followed with the new diagnostic and therapeutic approach. However, the natural history of the disease is often prolonged, and the survival benefits of local therapy for men with low-risk tumours may not be realized for a decade or more, as is increasingly well demonstrated in long-term observational cohorts in both Europe and United States. A significant proportion of men with prostate cancer is overdiagnosed, in the sense that diagnosis may not improve their lifespan or quality of life. However, the extent to which over-diagnosis represents a true problem relates to the consistency with which diagnosis leads invariably to active treatment. Mainly due to PSA screening, prostate cancer is diagnosed at progressively earlier stages and with lower risk features; despite these trends, there are less patients now than a decade ago who undergo a trial of active surveillance only. Rates of brachytherapy and hormonal therapy have risen markedly. Important progress has been achieved in recent years in prostate cancer risk assessment. These advances, in combination with biomarkers in later stages of development, should be expected in the next years to yield further improvements in clinicians’ ability to diagnose prostate cancer early, and guide appropriately selected patients toward the tailored treatment. 

Key words:
prostate cancer, prostatic specific antigen, prostatic specific antigen era, population based screening, opportunistic screening, indolent prostate cancer, high-risk prostate cancer, prostatic specific antigen relapse, active surveillance, watchful waiting.