1. Recent Advances in Prostate Cancer: What the Patients needs to know 2008
Per-Anders Abrahamsson
Department of Urology
Malmö University Hospital
Malmö, Sweden
Europa Uomo, Milan, March 29,2008

2. Incidence
Mortality

3. Anatomical Radical prostatectomy
Prostate Cancer: the 1980s
PSA:
Anatomical Radical prostatectomy
Stamey et al, NEJM 1987; Walsh et al, Prostate 1983

4. G.D. Chisholm
Chisholm, BJU 1993

5. SPCG 4 Holmberg et al, NEJM 347: 781, 2002
Steineck et al, NEJM 347: 790, 2002

6. SPCG-4: Mortality p = 0.01 RR = 0.56 Years to follow-up
Cumulative incidence of death from prostate cancer (%)
Radical prostatectomy
Watchful waiting
p = 0.01 RR = 0.56
Years to follow-up
No. at risk
Radical prostatectomy
Watchful waiting
Watchful waiting < 65 years
Radical prostatectomy < 65 years
Radical prostatectomy ≥ 65 years
Watchful waiting ≥ 65 years
Cumulative incidence of death from prostate cancer (%)
Note to Professor Abrahamsson: please check that the animation on this slide is as you would like it.
SPCG-4
This trial clearly shows a benefit of radical prostatectomy over watchful waiting when looking at death from PCa, death from any cause, and metastasis
Limitations:
Non-screen-detected cases
Predominantly T2 tumours
Lymph-node metastases were found in 10% of patients in the radical prostatectomy group
Criteria for local progression unreliable
DRE, bladder outflow obstruction requiring transurethral resection
High-grade disease excluded
Pathological stage insufficiently detailed (positive margins plus upstaging)
Morbidity from surgery was high
Radiotherapy was not evaluated
Years to follow-up
Bill-Axelson A, et al. N Engl J Med. 2005;352:

7. Radical prostatectomy Watchful waiting
Prostate Cancer: the 1990s
Radical prostatectomy
Curative surgical ‘gold standard’
Watchful waiting
Men with less than 10 years life expectancy
Men with co-morbidities

8. However, We did not anticipate this…
“ A ROBOT SAVED MY SEX LIFE…”
Daily Mail

9. Nor forsee Viagra coming.....

10. But will the robot really replace the surgical hand?

11. Robotic-assisted surgery
The Future?

12. Prostate-Specific Antigen
Best cancer marker ever discovered
Used for:
Detection and screening
Prognosis &
Monitoring of prostate cancer

13. HEALTHY & BENIGN DISEASE
Reality of PSA Testing
HEALTHY & BENIGN DISEASE
CUT OFF
PROSTATE CANCER
PSA
Ng/mL
20%
FALSE NEG.
70%
FALSE POS.

14. The Problem……. Normal / BPH Prostate Cancer
Potentially Lethal prostate cancer
Prostate Cancer
IDEAL SCREENING TEST
Normal / BPH

15. DD3...DD3PCA3…PCA3
PCA3DD3
(Bussemakers et al., Cancer Res. 59: , 1999)
Overexpressed in >95% of PrCa 1 2 3 4 5 6 T B N T N T N T N M
(kb)
4.0
DD3
2.0
0.6