... converted by the enzyme 5α-reductase to dihydrotestosterone in the gland. The periurethral portion ofthegland increases in size during puberty and after the age of 55 due to the growth of nonmalignant ... Diseases oftheProstate Benign and Malignant Diseases ofthe Prostate: Introduction Benign and malignant changes in theprostate increase with age. Autopsies of men in the eighth decade of life ... examination (DRE). Prostate Cancer In 2007 in the United States, ~218,890 prostate cancer cases were diagnosed, and 27,050 men died from prostate cancer. The absolute number of prostate cancer...
... proviso that the risks and benefits ofthe performance of these Chapter 091. Benign and Malignant Diseases oftheProstate (Part 2) Diagnosis and Treatment by Clinical State The disease ... trial. Theprostate cancer detection rate was 18.4% (803 of 4364) in the finasteride group and 24.4% (1147 of 4692) in the placebo group. Early concerns that the cancers detected in the finasteride ... were high-grade [37% (280 of 757 cancers) vs. 22% (237 of 1068 cancers) for the placebo group] have been shown to be an artifact ofthe reduced volume ofthe malignant epithelial cells in finasteride-treated...
... amount of cancer is quantified based on the length ofthe tumor within the core and the percentage ofthe core involved. accuracy for men with a PSA between 4 and 10, the risk of cancer ... Malignant Diseases oftheProstate (Part 3) The PSA criteria used to recommend a diagnostic prostate biopsy have evolved over time. The goal is to increase the sensitivity ofthe test for younger ... to die ofthe disease and to reduce the frequency of detecting cancers of low malignant potential in elderly men more likely to die of other causes. Age-specific reference ranges reduce the upper...
... confined to thegland (T2), and those that have extended outside thegland (T3 and T4) (Table 91-1). DRE alone is inaccurate with respect to the extent ofthe disease within the gland, the presence ... transitional cell tumorsofthe bladder invade thegland by direct extension. When prostate cancer is diagnosed, a measure of histologic aggressiveness is assigned using the Gleason grading ... Diseases oftheProstate (Part 4) Pathology The noninvasive proliferation of epithelial cells within ducts is termed prostatic intraepithelial neoplasia. PIN is a precursor of cancer,...
... radiation therapy, or active surveillance. Choice of therapy requires the consideration of several factors: the presence of symptoms, the probability that the untreated tumor will adversely affect the ... treatment, and the probability that the tumor can be cured by single-modality therapy directed at theprostate or requires both local and systemic therapy to achieve cure. As most ofthetumors detected ... treatment. Data from the literature do not provide clear evidence for the superiority of any one treatment. Comparison of outcomes of various forms of therapy is limited by the lack of prospective...