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Whats New in Prostate Cancer?
Per-Anders Abrahamsson, Department of
Urology Malmö University Hospital Sweden EAU,
Berlin, March 24, 2007
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Global incidence of prostate cancer
lt7.4 lt13.8 lt24.5 lt40.7 lt124.8
Age-standardised incidence rates per 100,000
GLOBOCAN 2002
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Mortality in different countries 1992 - 1995
Norway
Schwitzerland
Sweden
Denmark
New Zealand
Australia
Netherlands
Irland
Finland
USA
Austria
England
Germany
Canada
France
Spain
Israel
Italy
Mexico
Greece
Russia
Japan
Landis et al 1998
Mortality per 100,000 men
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Prostate-Specific Antigen

• Best cancer marker ever discovered
• Used for
• Detection and screening
• Prognosis
• Monitoring of prostate cancer

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The Ultimate Goal of Early Detection for Prostate
Cancer
Locally advanced
PIN
N
Organ-confined
M
Vol. (ml) 1 4 25
100 1000
PSA (ng/ml) 3 10 20 200
300 700
Window of curability
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Is PSA still useful ?
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Prostate Cancer
2006
1991
15 mm3
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Reality of PSA Testing
HEALTHY BENIGN DISEASE
CUT OFF
PROSTATE CANCER
PSA Ng/mL
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 100.0
70 FALSE POS.
20 FALSE NEG.
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PSA and Prostate Cancer
Thompson IM et al. N Engl J Med 20043502239-46
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The Problem
Normal / BPH
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European Randomized Study of Screening for
Prostate Cancer (ERSPC)

• Overdiagnosis remains a concern Schröder F,
  WHO, 2004

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Early Detection/Screening

• Most screening-detected prostate cancers are less
  aggressive

Andriole GL. J Natl Cancer Inst. 200597433-8.
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PSA era is not overWe should use PSA better!

• PSA provides a continuum of risk assessment
• Do not focus only on total PSA cutoff
• Repeat PSA measurement and rule out prostatitis
• Use PSA velocity or doubling time, and
• free and complexed PSA, proPSA

Catalona, J Urol, 2005
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How to Predict Development of Prostate Cancer on
an Individual Basis

• Can Plasma levels of PSA
• predict long-term risk
• for Prostate Cancer ?

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Risk for Prostatate Cancer Diagnosis in Men lt 53
years at Blood Sampling and with follow up ?13
to 25 years
Lilja, Abrahamsson et al., J Clin Onc 2007
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Screening Scenario

• How avoid overtreatment
• Use of the long therapeutic window to guide
  treatment
• PSA kinetics PSA Doubling Time or PSA Velocity
  as a guide to intervention

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The take-home-messages- PSA Kinetics -

• Simple, inexpensive and readily available
• Should be incorporated into patient risk
  assessment !

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• PCA3DD3 is the most prostate-cancer-specific gene
  described to date
• Over-expressed in gt95 of PC
• Expression restricted to the prostate

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Cells in prostatic urethra
Digital Rectal Exam (DRE)