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

Incidence

Mortality

Prostate Cancer: the 1980s

• PSA:

• Anatomical Radical prostatectomy

Stamey et al, NEJM 1987; Walsh et al, Prostate 1983

G.D. Chisholm

Chisholm, BJU 1993

Steineck et al, NEJM 347: 790, 2002

Holmberg et al, NEJM 347: 781, 2002

SPCG

4

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

However, We did not anticipate this…

“ A ROBOT SAVED MY SEX

LIFE…” Daily Mail

Nor forsee Viagra coming.....

But will the robot really replace the surgical hand?

Robotic-assisted surgeryRobotic-assisted surgery

The Future?The Future?

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.

The Problem…….

Normal / BPH

Prostate Cancer

Potentially Lethal prostate cancer

IDEAL SCREENING TEST

(kb)

DD3

4.0

T N NN TTB

2.0

T N

321 4 65

0.6

M M

• PCA3DD3

(Bussemakers et al., Cancer Res. 59: 5975-79,

1999)

• Overexpressed in >95% of PrCa

DD3...DD3PCA3…PCA3