Prostate cancer for the internist

Abstract

In the United States, approximately 240,000 men are diagnosed annually with prostate cancer. Although effective treatment options are available for clinically localized cancer, the potential burdensome co-morbidities and attendant healthcare costs from over diagnosis and over treatment have escalated the discussion and controversy regarding appropriate screening, diagnosis, and optimal management of prostate cancer. Although the lifetime risk of developing prostate cancer is approximately 1 in 6 (~16%), the risk of dying from the disease is only ~2%. The discrepancy between the cancer incidence and lethality has led to widespread scrutiny of prostate cancer patient management, particularly for low-grade, low-stage (indolent) disease. The vast majority of men diagnosed with clinically localized prostate cancer are treated with interventional therapies despite studies demonstrating that even without treatment, prostate cancer-specific mortality is low.A MedLine/PubMed search was performed using PICO format (Patient, Intervention, Comparison and Outcome) identifying all relevant articles. No restrictions were used for publication dates. The terms “Prostate Cancer”, “Screening”, “Mortality”, “Morbidity” yielded 307 results. “Diagnosis”, “Prognosis” and “Survival” yielded 1504 results. Further filters were applied to narrow down the results using keywords “Prostate cancer screening guidelines 2014”, “Beyond PSA”, “NCCN Guidelines prostate”, “MRI guided Prostate biopsy” yielding 72, 274, 54 and 568 results respectively. Of these, approximately 137 articles were found relevant and were reviewed. References from the reviewed articles were included in the final article.

Acetyl-L-Carnitine downregulates invasion (CXCR4/CXCL12, MMP-9) and angiogenesis (VEGF, CXCL8) pathways in prostate cancer cells: rationale for prevention and interception strategies

“…Prostate cancer (PCa) represents the most commonly diagnosed malignancy in men and the second cause of male cancer death worldwide [1, 2]. Substantial evidence suggests that chronic inflammation and angiogenesis contribute to tumour initiation, metastasis, and progression [3–6].…”

Inactivation of the Wnt/β-catenin signaling pathway underlies inhibitory role of microRNA-129-5p in epithelial–mesenchymal transition and angiogenesis of prostate cancer by targeting ZIC2

“…Prostate cancer (PCa) is a most frequently occurring malignancy among older men [1, 2]. Prostate tumors are usually indolent, but a considerable number of tumors are highly aggressive and often metastasize to bones and other organs, leading to high morbidity and mortality [3, 4]. In addition, PCa is typically marked by a high recurrence rates, whereby about 40% of local PCa cases recur after initial treatment, and the tumor progresses to hormone refractory/castration resistance stage is basically untreatable [5, 6].…”

Large Health Systems’ Prevention Guideline Implementation: A Qualitative Study

“…They can also occur when guidelines from outside organizations diverge, as with breast and prostate cancer screening recommendations. 10,11 Interviewees reported that their quality improvement committees, sometimes in combination with compensation committees, work to understand the differences, better align metrics across payer contracts when possible, and identify internal organization-wide metrics.…”