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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
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Incidence Mortality
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Anatomical Radical prostatectomy
Prostate Cancer: the 1980s PSA: Anatomical Radical prostatectomy Stamey et al, NEJM 1987; Walsh et al, Prostate 1983
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G.D. Chisholm Chisholm, BJU 1993
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SPCG 4 Holmberg et al, NEJM 347: 781, 2002
Steineck et al, NEJM 347: 790, 2002
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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:
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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
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However, We did not anticipate this…
“ A ROBOT SAVED MY SEX LIFE…” Daily Mail
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Nor forsee Viagra coming.....
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But will the robot really replace the surgical hand?
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Robotic-assisted surgery
The Future?
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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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HEALTHY & BENIGN DISEASE
Reality of PSA Testing HEALTHY & BENIGN DISEASE CUT OFF PROSTATE CANCER PSA Ng/mL 20% FALSE NEG. 70% FALSE POS.
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The Problem……. Normal / BPH Prostate Cancer
Potentially Lethal prostate cancer Prostate Cancer IDEAL SCREENING TEST Normal / BPH
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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
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