Prognostic Implications of Important Genetic Alterations in Prostate Cancer

The prostate is a walnut-sized gland that is located caudally from the urinary bladder. It excretes fluid as a part of the semen of men. Prostatic neoplasia is common; in Western developed countries prostate cancer is the most common non-cutaneous malignancy in men and it is the second leading cause of all male cancer deaths. The detection of prostate cancer has markedly increased since the introduction of the serum prostatespecifi c antigen (PSA) in the late eighties. Although familial and hereditary prostate cancer occurs, sporadic cancers account for at least 85% of all prostate cancers. Age is the strongest risk factor for developing prostate cancer. From autopsy studies it is known that in the 6th decade already 55% of the male population has the disease, and more than 75% of men older than 85 years have cancer foci in their prostate. Prostate cancer is a very heterogeneous disease that can range from indolent, asymptomatic tumours in many patients to a rapidly fatal malignancy in some. At diagnosis, the majority of tumours are confined to the prostatic gland, named clinical stage cT1 and cT2 (see Table 1 for the Tumour, Node, Metastasis (TNM) classifi cation). Some tumours, however, already grow outside the prostatic capsule (cT3) or even invade the surrounding organs (cT4). Dissemination of the disease usually occurs to the regional pelvic lymph nodes and the axial skeleton. The latter will mainly cause pain, although neurological deficit due to compression of the myelum is also possible in severe cases. Diagnostic modalities to detect prostate cancer are digital rectal examination (DRE), measurement of the serum prostate-specific antigen (PSA), transrectal ultrasound of the prostate (TRUS) with subsequent ultrasound-guide

De behandeling van blaaskanker vraagt om gecentraliseerde zorg

Quality of care for bladder cancer patients differs between Dutch hospitals. Improving the collaboration between hospitals, focussing on healthcare pathways and outcome measures will be helpful in establishing quick improvements. In this respect it is important to incorporate patient related outcome measures

De rol van circulerende tumorcellen bij het urotheelcarcinoom van de blaas

Patients with muscle-invasive urothelial cell carcinoma of the bladder have a 50 % chance to develop distant metastases despite curative local treatment. Reliable markers that predict the risk of developing metastases or that could be used to determine whether or not perioperative systemic treatment should be given are lacking. Circulating tumor cells (CTCs) are cancer cells that are present in the blood stream of patients with solid tumors and originate from tumor lesions that are present in the body. The enumeration of CTCs is an attractive option to assess the chance to develop distant metastases in individual patients. Here, we set out to review the most relevant literature to date regarding the clinical value of CTCs in bladder cancer. Moreover, the CirGuidance study is presented, which is the first interventional trial, which uses CTCs to guide treatment choices regarding the administration of neoadjuvant chemotherapy in patients with muscle-invasive urothelial cell carcinoma