ABC of Prostate Cancer E-Book

Prokar Dasgupta

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: ABC Series
• Sprache: Englisch

Seitenzahl: 220

Veröffentlichungsjahr: 2011

Beschreibung

Prostate cancer is the most common cancer in men in the UK and US and the second most common worldwide.

The ABC of Prostate Cancer provides fully illustrated guidance on the treatment and management of prostate cancer. It covers the biology, anatomy, and pathology of prostate cancer, screening, and active surveillance and monitoring. It presents an assessment of treatment options including prostatectomy, bracytherapy, chemotherapy and immunotherapy, along with modern diagnostic tests and an overview of new approaches to prostate cancer.

With an international author team, the ABC of Prostate Cancer is ideal for general practitioners, family physicians, specialist nurses, junior doctors, medical students and others working with prostate cancer patients and their families.

Leseprobe

Table of Contents

Title Page

Series Page

Copyright

Contributors

Foreword

Chapter 1: Applied Anatomy of the Prostate

The basic anatomy

Lymphovascular supply

Zonal anatomy

Neuroanatomy

Chapter 2: Pathology of Prostate Cancer

Introduction

Morphology of prostate cancer

Prognostic factors in prostate cancer

Role of the needle biopsy in the management of prostate cancer

Chapter 3: Biology of Prostate Cancer

Introduction

Genetic factors

Environmental factors

Conclusion

Further reading

Chapter 4: Prostate Cancer Diagnosis

Presentation

The value of a digital rectal examination (DRE)

The use of imaging for diagnosis of prostate cancer

Novel approaches to diagnosis of prostate cancer

Chapter 5: Imaging of Prostate Cancer

Introduction

Plain imaging

Trans-rectal ultrasound (TRUS)

Computed tomography (CT)

Magnetic resonance imaging (MRI)

Radionuclide bone scintigraphy (bone scan)

Potential or future imaging modalities

Chapter 6: Screening for Prostate Cancer

Introduction

Principles of screening

Future developments

Conclusion

Chapter 7: Active Surveillance

Introduction

What is active surveillance?

Why is active surveillance an option in prostate cancer?

What is the difference between active surveillance and watchful waiting?

How is active surveillance undertaken?

What is the evidence for active surveillance?

For which patients is active surveillance an option?

Benefits of active surveillance

Potential risks of active surveillance

When to identify that the disease has progressed?

Future directions

Conclusion

Further reading

Chapter 8: Open Radical Prostatectomy

Introduction

Indications

Surgical technique

Complications

Chapter 9: Laparoscopic Radical Prostatectomy

Introduction

Advantages of laparoscopy

History of laparoscopic radical prostatectomy

Patient selection

Operative details Position

Training

Cost

Conclusion

Chapter 10: Robotic Radical Prostatectomy

Introduction

Robotic technology

Surgical approach and technique

Outcomes data

Controversies

Chapter 11: Prostate Brachytherapy

Introduction

Chapter 12: HIFU

Introduction

History of HIFU

Physical principles of HIFU

Platforms and procedure

Indications

Contra-indications

Summary of published results

Future applications

Chapter 13: Cryotherapy for Prostate Cancer

Introduction

The development of cryosurgery for prostate cancer

Mechanism of tissue injury in prostate cryotherapy

Patient groups amenable to total cryosurgical ablation of the prostate primary therapy—organ-confined disease

Primary therapy—locally advanced disease

Salvage therapy after external beam radiotherapy or brachytherapy

Patient selection for primary cryotherapy

Patient selection for salvage cryotherapy after EBRT or brachytherapy

Technique of cryosurgical ablation of the prostate

Primary cryotherapy of the prostate

Complications of primary cryotherapy of the prostate

Oncological results of salvage cryotherapy series

Complications of salvage cryotherapy series

Focal nerve-sparing primary cryotherapy

Chapter 14: Advances in External Beam Radiotherapy

Introduction

Advances in target localisation: image-guided radiotherapy (IGRT)

Advances in radiotherapy delivery

Chapter 15: Recent Advances in Hormonal Therapy

Introduction

Mode of action

Advanced prostate cancer

Neoadjuvant and adjuvant hormonal therapy

Side-effects of hormonal therapy

Conclusion

Chapter 16: Management of Castration-Resistant Prostate Cancer

Introduction

Conclusion

Chapter 17: Immunology of Prostate Cancer

Prostate cancer and the immune system

The concept of immunoediting

Factors that cause immunosuppression in prostate cancer

Immunotherapy strategies

Conventional treatment and immunology

Clinical trials in prostate cancer immunotherapy

Conclusion

Chapter 18: New Approaches to Prostate Cancer

New approaches to prostate cancer

New treatments for localised prostate cancer

New treatments for metastatic prostate cancer

Index

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Library of Congress Cataloging-in-Publication Data

ABC of prostate cancer / edited by Prokar Dasgupta, Roger S. Kirby ; foreword by Peter T. Scardino.—1st ed.

p. ; cm. -- (ABC series)

Includes bibliographical references and index.

ISBN-13: 978-1-4443-3437-1 (pbk. : alk. paper) ISBN-10: 1-4443-3437-9 (pbk. : alk. paper)

1. Prostate—Cancer. I. Dasgupta, Prokar. II. Kirby, R. S. (Roger S.) III. Series: ABC series (Malden, Mass.)

[DNLM: 1. Prostatic Neoplasms. WJ 762]

RC280.P7A23 2012

616.99′463—dc23

2011015319

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9781444346909; ePub 9781444346916; Mobi 9781444346923

Contributors

Peter Acher

Specialist Registrar in Urology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK

Hashim U. Ahmed

MRC Fellow in Uro-oncology and Clinical Lecturer in Urology, Division of Surgery and Interventional Sciences, University College Hospital London, London, UK

Richard J. Bryant

NIHR Clinical Lecturer in Urology, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK

Declan Cahill

Consultant Urological Surgeon, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK

Ben Challacombe

Consultant Urological Surgeon, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK

Ashish Chandra

Consultant Pathologist, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK

Anthony J. Costello

Professorial Fellow, Department of Urology, The Royal Melbourne Hospital, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Prokar Dasgupta

Consultant Urological Surgeon, Department of Urology, King's College London, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK

Reena Davda

Specialist Registrar in Clinical Oncology, University College Hospital London, London, UK

John Davies

Consultant Urological Surgeon, University of Surrey, Guildford, UK

Louise Dickinson

Clinical Research Fellow in Urology, Division of Surgery and Interventional Sciences, University College Hospital London, London, UK

Judith Dockray

King's College London, London, UK

Oussama Elhage

Medical Research Council Centre for Transplantation, King's College London, London, UK

Mark Emberton

Professor of Interventional Oncology, University College London and Honorary Consultant Urological Surgeon, University College Hospital London, London, UK

Mark R. Feneley

Consultant Urologist, University College Hospital London, London, UK

John M. Fitzpatrick

Professor of Surgery, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland

Christine Galustian

King's College London, London, UK

James Halls

Specialist Registrar Radiology, Department of Radiology, St George's Healthcare NHS Trust, London, UK

Freddie C. Hamdy

Nuffield Professor of Surgery, Professor of Urology and Head, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK

Wim van Haute

Urological Surgeon, Department of Urology, St Rembert Hospital, Torhout; St Jan Hospital, Bruges, Belgium

Alastair Henderson

Consultant Urological Surgeon, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK

Lars Holmberg

Professor of Cancer Epidemiology, Division of Cancer Studies, Medical School, King's College London, London, UK

Roger S. Kirby

Consultant Urologist, The Prostate Centre, London, UK

Pardeep Kumar

Specialist Registrar in Urology and Intuitive Fellow in Robotics, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK

David Landau

Consultant Clinical Oncologist, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK

Gordon Muir

King's College London, London, UK

Declan G. Murphy

Uro-Oncologist, The Peter MacCallum Cancer Centre, Associate Professor of Urology, University of Melbourne, Melbourne, VIC, Australia

Uday Patel

Consultant Radiologist, Department of Radiology, St George's Healthcare NHS Trust, London, UK

Heather Payne

Consultant in Clinical Oncology, University College Hospital London, London, UK

Jim Peabody

Attending Urologist and Fellowship Director at Henry Ford Health System, Henry Ford Hospital, Detroit, MI, USA

Rick Popert

Department of Urology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK

Hein van Poppel

Full Professor of Urology, Katholieke Universiteit, Chairman Department of Urology, University Hospital Gasthuisberg, Leuven, Belgium

Asad Qureshi

Clinical Fellow in Clinical Oncology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK

Megan S. Schober

Department of Urology, William Beaumont School of Medicine at Oakland University, Royal Oak, MI, USA

Karl-Dietrich Sievert

Professor of Urology, Director, Uro-oncology, Neurourology, Incontinence and Reconstructive Urology, Department of Urology, University of Tübingen, Tübingen, Germany

Richard Smith

Medical Research Council Centre for Transplantation, King's College London, London, UK

Prasanna Sooriakumaran

Visiting Fellow in Urology, Robotic Prostatectomy and Urologic Oncology Outcomes, James Buchanan Brady Foundation Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA

Abhishek Srivastava

Research Associate, Robotic Prostatectomy and Urologic Oncology Outcomes, James Buchanan Brady Foundation Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA

Ashutosh Tewari

Ronald P. Lynch Professor of Urology, Director- LeFrak Center for Robotics, Director- Prostate Cancer Institute, James Buchanan Brady Foundation Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA

Murali Varma

Consultant Histopathologist, University Hospital of Wales, Cardiff, UK

Nadia Walsh

Superintendent Planning Radiographer, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK

R. William G. Watson

Associate Professor of Cancer Biology, UCD School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland

Robin Weston

Department of Urology, The Royal Melbourne Hospital, The Peter MacCallum Cancer Centre, The Australian Prostate Cancer Research Centre, Epworth Richmond Hospital, Melbourne, VIC, Australia

Foreword

Men diagnosed with prostate cancer, and the physicians who care for them, are faced with a wealth of information about this disease, including a variety of treatment options. Conflicting expert opinions make it especially difficult to choose with confidence the right treatment at the right time. This new edition of the ABC series, “ABC of Prostate Cancer,” provides a clear, comprehensive, up-to-date overview of all aspects of the diagnosis and treatment of prostate cancer. It might have been called “Prostate Cancer from A to Z.” In essence, it is a collection of chapters by world renowned experts in the field. Clearly written, comprehensive yet concise, and beautifully illustrated, this volume will provide a good starting point for physicians and medical personnel who are not experts in prostate cancer. The volume is thorough and covers virtually every aspect of prostate cancer treatment. The chapters on new treatment approaches are particularly impressive.

We are living through a revolutionary time in the development of systemic therapy for prostate cancer, including hormonally active agents such as abiraterone and MDV3100, the new antiandrogen produced by Charles Sawyers and developed by the Medivation. The first vaccine for prostate cancer approved by the United States FDA, sipuleucel-T, has launched a new era in the immunotherapy of cancer. This volume describes those advances and recently approved systemic chemotherapy drugs in detail. For localized prostate cancer, the chapters on robotic assisted laparoscopic prostatectomy and on focal therapy, an unproven yet highly attractive approach now undergoing testing in clinical trials, are well presented.

The reader should be cautioned, however, that these chapters represent the optimistic view of experts who are advocates for the diagnostic or treatment approach that they describe. The chapters do not represent the consensus of a multidisciplinary panel of experts. That makes this book an excellent place to start when one is interested in a concise, state-of-the-art overview of each approach, but more information would be necessary before a final, informed decision should be made.

As the author of a book on prostate cancer for the layman and a practicing physician myself, I often point out to patients that prostate cancer is a condition that warrants a second or even third opinion from experts across the fields of urology, medical oncology and radiation oncology before a final decision is reached. A thoughtful patient is wise to ask his personal physician to help digest the sometimes contradictory opinions offered by specialists. Those of us within the field of prostate cancer know that how well a treatment is delivered is as important as which treatment one chooses, so experience and expertise in the chosen treatment is crucial to realizing the best outcome.

The medical community should welcome this new approach to providing comprehensive yet concise information about the state of the art for prostate cancer. The authors of these chapters and the editors who organized this new text should be congratulated. This is a fine place to begin to learn about one of the more complicated and controversial diseases that men face.

Peter T. Scardino, MD

The David H. Koch Chair

Chairman, Department of Surgery

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

Chapter 1

Applied Anatomy of the Prostate

Prasanna Sooriakumaran1, Karl-Dietrich Sievert2, Abhishek Srivastava1,Ashutosh Tewari1,

1Prostate Cancer Institute and Lefrak Center of Robotic Surgery, James Buchanan Brady Foundation Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA

2Department of Urology, University of Tübingen, Tübingen, Germany

Overview

The prostate is composed of four zones: transitional, central, peripheral, and anterior fibromuscular stromaThe ejaculatory ducts open into the prostatic urethra on either side of the verumontanumThe external urethral sphincter (both voluntary and involuntary elements) lies immediately distal to the verumontanum while the internal urethral sphincter (involuntary) lies at the bladder neckThe prostate lies in a hammock of nerves which can be divided into three zones: proximal neurovascular plate, predominant neurovascular bundles, and accessory distal neural pathways Cavernous nerves exceed the posterolateral track and distribute in a more widespread range from anterolateral to posterior of the glandThe prostate is surrounded by prostatic fascia andendopelvic fascia, with Denonvillier's fascia separating it from the fascia propria of the rectum

The basic anatomy

The prostate gland develops after puberty as a result of the testosterone surge. It reaches a size of 20cc in the normal adult, measuring 3 cm in length, 4 cm in width, and 2 cm in depth. Its size and shape can be approximated to that of a walnut. It is located at the base of the bladder, where it surrounds the proximal urethra. In this position, it lies above the urogenital diaphragm between the rectum and the symphysis pubis (Figure 1.1). It is described as having anterior, posterior, and lateral surfaces. Its base is contiguous with the bladder and its apex narrows inferiorly. There is no ‘true’ capsule to the prostate, but rather a ‘false’ capsule of fibromuscular stroma which disappears towards the apex of the gland. The prostate is surrounded by fascial structures (Figure 1.2) anteriorly and anterolaterally by the prostatic fascia, and posteriorly by Denonvillier's fascia which separates it from the fascia propria of the rectum. Laterally, the prostatic fascia merges with the endopelvic fascia (also called the lateral pelvic or levator fascia). The prostatic base is covered with a posterior layer of detrusor apron from the bladder muscle. Abutting the prostate posteriorly are the seminal vesicles and vasa (ducti) deferentia (Figure 1.3).

Figure 1.1 Sagittal section of the male pelvis.

Figure 1.2 Fascial relations of the prostate.

Figure 1.3 The posterior relations of the prostate.

The prostate gland itself is composed of ducts and alveoli that are lined by tall columnar epithelium (70%) within a stroma of fibromuscular tissue (30%). The urethra does not run straight through the middle of the gland as is the common medical student misconception, but rather takes a curved course, running anteriorly as it proceeds from proximal to distal, such that it ends up close to the prostate's anterior surface. It is lined by transitional epithelium throughout most of its length, and squamous epithelium at its distal end, hence, cancer of the urethra is either transitional cell or squamous cell carcinoma, and not adenocarcinoma as for the prostate. Those urothelial cancers are highly aggressive. A urethral crest runs the length of the prostate and disappears in the striated external urethral sphincter (rhabdosphincter). The prostatic sinuses run alongside the crest and all the prostatic glands discharge into this. The small slit of the prostatic utricle is found on the verumontanum (colliculus). The ejaculatory ducts open just lateral to the verumontanum and this is where the seminal vesicle contents are discharged (via the vasa) during emission (Figure 1.4). This allows the seminal fluid to mix with the prostatic secretions such that the final ejaculate is a mixture of these two components.

Figure 1.4 Cross-sectional anatomy of the male lower urinary tract.

Just proximal to the verumontanum is the external urethral sphincter (EUS) which is a horseshoe-shaped structure which surrounds the prostatic apex craniodorsolaterally, is deficient posteriorly, and has both striated (voluntary) and smooth muscle (involuntary) components. Hence, during a transurethral resection of the prostate (TURP) for benign prostatic enlargement (BPE), the verumontanum serves as the limit for proximal resection so that the EUS is not damaged. The internal urethral sphincter is located at the bladder neck where the prostato-vesical junction is, and is purely under involuntary control (hence, it is composed of smooth muscle). It not only completes the continence mechanism but also makes antegrade ejaculation possible. The internal urethral sphincter is invariably damaged during a TURP so that, were the EUS to also be damaged, then urinary incontinence would be inevitable. This is why the verumontanum (or ‘veru’ to those that know it well) is such an important landmark during TURP.

Lymphovascular supply

The arterial supply to the prostate arises from the inferior vesical artery (itself a branch of the internal iliac artery). As the inferior vesical artery approaches the prostate gland, it becomes the prostatic artery. This then divides into two main groups of arteries: the urethral group and the capsular group. The urethral arteries penetrate the prostato-vesical junction posterolaterally and travel inward, perpendicular to the urethra. They approach the bladder neck in the 1- to-5 o'clock and 7- to-11 o'clock positions, with the largest branches located posteriorly. The capsular artery gives off a few small branches to the false capsule of the prostate, but, in the main, runs posterolaterally to the prostate along with the cavernous nerves (to form the so-called neurovascular bundle), before ending at the urogenital diaphragm.

The venous drainage of the prostate is via the periprostatic plexus of veins to both the dorsal venous complex (of Santorini) superiorly and the inferior vesical vein to the hypogastric vein. These then both drain into the internal iliac vein. The dorsal venous complex (DVC) lies over the anterior aspect of the prostate and is the commonest source of bleeding during a radical prostatectomy. Just lateral to the DVC are the puboprostatic ligaments (PPL) which are condensations of the endopelvic fascia and attach the prostate to the pubic symphysis. The PPL may be important in maintaining continence, and are thus often spared during radical prostatectomy.

As is true of much human anatomy, the lymphatic drainage of the prostate follows that of the veins. Hence, for the prostate, this is to the obturator and hypogastric nodes, and then on to the internal iliac and aortic nodes. It is important to note, however, that prostatic lymphatic drainage is not always predictable in a stepwise manner, and 25% of cases of prostate cancer drain directly to nodes outside the pelvis (internal iliac or higher), making the extent of pelvic lymphadenectomy in high-risk prostate cancer a subject of much debate.

Zonal anatomy

Throughout the nineteenth century, the prostate was described as having two lobes, with each lobe having its own ducts. In 1906, Howe described a middle (or median) lobe. In 1912, Lowsley described five lobes: two lateral lobes, a posterior lobe, the middle lobe, and an atrophied embryological anterior lobe. However, these lobes were visible only in BPE and not the normal prostate. This lobar concept thus left much to be desired, and in 1968, McNeal replaced it with his concentric zones concept (Figure 1.5).

Figure 1.5 McNeal's zones of the prostate.

The transition zone consists of 5–10% of the glandular tissue of the prostate and is responsible for most of the BPE that affects the prostates of older men. The prostatic ducts lead into the junction of the pre-prostatic and prostatic urethra, and travel on the posterolateral aspects of the EUS.

The ducts of the central zone arise circumferentially around the openings of the ejaculatory ducts. These glands are histologically distinct and appear to be Wolffian (mesonephric) in embryological origin. Only 1–2% of prostate cancers arise from this zone.

The peripheral zone makes up 60% of the prostatic volume. Its ducts drain into the prostatic sinus along the entire length. Some 70% of carcinomas arise from this zone which is also commonly affected by prostatitis (hence, prostatitis and cancer can co-exist in men).

The anterior fibromuscular stroma makes up approximately 30% of the gland, and extends from the bladder neck to the EUS anteriorly. It is compressed in BPE and rarely involved in prostate cancer, though anterior cancers should be suspected when repeat conventional prostatic biopsies which do not sample the anterior aspects well come back negative; hence, the use of saturation or template biopsies to sample these anterior aspects.

Neuroanatomy

Using dissections of male fetuses and newborn cadavers, Walsh and Donker first demonstrated the course of the cavernous nerve (the main nerve responsible for erectile function). This led to the concept of the macroscopic neurovascular bundle (NVB) that is located between the endopelvic and prostatic fasciae and runs along the posterolateral aspect of the prostate until it enters the urogenital diaphragm. However, recently, there have been observations that refute the dogma that the cavernous nerve is always within the NVB. Using intraoperative electrical stimulation with simultaneous measurement of intracavernosal pressure, our group, as well as others, discovered that the distribution of cavernous nerves was wider than that of the neurovascular bundle. Our group described the distribution of these nerves and they can be thought of as forming three broad zones: the trizonal concept.

The first zone is the proximal neurovascular plate (PNP) which is located lateral to the bladder neck, seminal vesicles, and branches of the inferior vesical vessels. Proximally, the PNP is derived from the pelvic (inferior hypogastric) plexus and cavernous nerves run in its most distal part. It is not only composed of parasympathetic nerves as commonly thought, but also has sympathetic contributions from the hypogastric nerve. The second zone is the predominant neurovascular bundle (PNB) which corresponds with the classical NVB. The PNB is located between the endopelvic and prostatic fasciae at the posterolateral aspect of the prostate (the same as the NVB). The third zone is the accessory distal neural pathways (ANP). These smaller accessories off the PNB travel in the prostatic and Denonvillier's fasciae, and may serve as additional conduits for neural impulses to both the cavernous tissues and the EUS. The ANP can cross from one side to the other, and thus may also serve as a safety mechanism to provide back-up neural cross-talk between the two sides.

The prostate can be thought of as lying within a hammock of these nerves, so that the neural zones surround the majority of the gland. This concept is then very different to the conventional concept wherein the prostate lies between two NVBs that course its posterolateral aspects like train tracks.

Recent results show that the posterolateral accumulation of nerves (the NVB) is supplemented by additional main localisations in the anterior mid-part of the prostate and, even more so, on the posterior surface of the prostatic apex. The main extra-capsular prostatic nerves expand from the base to the mid of the prostate before they narrow in the posterolateral and posterior sectors around the prostate. The extent of these additional localisations of nerves seems to vary from individual to individual.

There is evidence for clear differences between the main localisations of nerve qualities along the prostate. Currently the consensus opinion for the most likely localisation of the nerve fibres responsible for erectile functionality is the posterior margin of the NVB. Recent studies provide a differential mapping of nerves of different characteristics. The localisations of cavernous nerves considerably seem to exceed the course of the posterolateral NVB both in the anterior and, to an even greater extent, in the posterior direction, resulting in a main localisation of erectile nerve fibres along an oblique shape in a base-lateral towards postero-apical track around the prostate (Figure 1.6).

Figure 1.6 Anatomy of the cavernous nerves.

Further reading

Sievert KD, Hennenlotter J, Laible I, Amend B, Schilling D, Anastasiadis A, et al. The periprostatic autonomic nerves: bundle or layer? Eur Urol 2008;54(5):1109–16.

Takenaka A, Tewari A, Hara A, Leung RA, Kurokawa K, Murakami G, et al. Pelvic autonomic nerve mapping around the prostate by intraoperative electrical stimulation with simultaneous measurement of intracavernous and intraurethral pressure. J Urol 2007;177(1):225–9.