Textbook of Prostate Cancer: Pathology, Diagnosis and Treatment - Hardcover

Denis, Louis J; Griffiths, Keith; Kaisary, Amir V; Murphy, Gerald P

9781853174223: Textbook of Prostate Cancer: Pathology, Diagnosis and Treatment

Hardcover

ISBN 10: 185317422X ISBN 13: 9781853174223

Publisher: CRC Press, 1999

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Textbook of Prostate Cancer covers major developments in diagnosis, surgery and medical treatment.

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From The New England Journal of Medicine:

For nearly three quarters of a century, it has been recognized that more than 30 percent of men over 50 years of age harbor a latent form of prostatic adenocarcinoma that is detected only on postmortem examination. Yet the rates of detection in populations of men screened with digital rectal examination, measurement of serum prostate-specific antigen, or both are only 1 to 5 percent. Still, clinically detected prostate cancer is the most common noncutaneous cancer in American men and the third most common cancer in men worldwide. Many men with prostate cancer die with this neoplasm rather than of it, yet it is the second leading killer of American men with cancer. The essence of this enigma presents one of the central challenges of prostate cancer: how are physicians to stratify prostate cancer according to aggressiveness, and which therapies should be used within these stratifications?

The Textbook of Prostate Cancer, an important and timely contribution, addresses these questions on a broad front. The book was written by experts from around the world, and the chapters span the spectrum from basic science to clinical diagnosis and treatment. For such a comprehensive endeavor, this is a relatively short book. Most of the chapters are concise and may not be sufficiently detailed for some readers. However, a valuable attribute of this work is that it is wide in scope but eminently readable. For those who seek additional details, the references are up to date and provide a base of accessible knowledge.

The opening chapter on the natural history of prostate cancer is a vital one. It is an excellent survey, which appropriately notes that there are very few reports on the true natural history of this malignant tumor. Many studies that have involved "watchful waiting," "surveillance only," or "expectant management" are actually reports of deferred treatment, with therapy instituted on evidence of clinical progression. Another critical point this chapter emphasizes is that all too often, many such studies are of highly selected patients, and therefore the results are difficult to compare with those of other studies. Furthermore, studies that involve watchful waiting typically enroll patients with low-grade and low-stage cancer. So, in fact, there are no data on the clinical course of untreated prostate cancer across the full range of histologic grades and stages. Outcome for the individual patient is currently best predicted by a combination of the serum prostate-specific antigen level, the clinical stage, and the histopathological grade of the cancer, but further refinement is needed for a more accurate prediction of the outcome. The use of molecular genetic abnormalities holds promise in this regard, but this book provides little information on the relation, if any, between specific DNA alterations in patients with prostate cancer and prognosis.

The subtitle of this treatise is Pathology, Diagnosis, and Treatment. Two of the 17 chapters are devoted to the pathology of prostate cancer, but only one photomicrograph is provided. There is not a single gross or microscopical image of prostate cancer in the chapter on the role of pathology in the biopsy, diagnosis, and management of prostate cancer. Since tumor differentiation (expressed as histologic grade) and the extent of tumor (volume and stage) are among the most powerful prognostic indicators for patients with prostate cancer, illustrations of examples of various grades and pathological stages would have been desirable. This is a minor aberration, since the book is otherwise illustrated with many fine figures. Well-situated tables nicely summarize textual information.

Potential precursors of prostate cancer include prostatic intraepithelial neoplasia and atypical adenomatous hyperplasia (also known as adenosis). The superb chapter on prostatic intraepithelial neoplasia meticulously proffers evidence in support of this condition as a proliferation that precedes some invasive cancers. The case for atypical adenomatous hyperplasia is more controversial and is mentioned only fleetingly in the book.

Measurement of serum prostate-specific antigen has had a profound effect on the diagnosis and management of prostate cancer. With the use of prostate-specific antigen measurements, there has clearly been a recent shift to the detection of smaller and lower-stage prostate cancers, with the majority being pathologically important. In well-balanced chapters on prostate-specific antigen, its practical uses and the controversy regarding prostate-specific antigen screening are highlighted. The diagnostic value of radiologic approaches (transrectal ultrasonography, nuclear medicine, computed tomography, and magnetic resonance imaging) are also placed in appropriate context.

A particular strength of this book is its presentation of the therapeutic options for patients with localized and metastatic prostate cancer. Radical prostatectomy and radiation therapy for clinically localized disease are thoroughly discussed. Newer developments in the treatment of localized prostate cancer, such as neoadjuvant hormonal therapy, computer-guided brachytherapy, and cryosurgery, are covered. There are outstanding and clearly written sections on the use of hormonal manipulation and chemotherapy in patients with metastatic disease. Possible future therapies for prostate cancer, including immunotherapy and gene therapy, are also described. The final chapter is a fine synthesis and overview of the field, written with an eye toward the next century.

I recommend this book to all physicians involved in the care of patients with prostate cancer. It should also serve as a valuable resource for scientists, basic researchers, and all health care professionals interested in this cancer.

Reviewed by Peter A. Humphrey, M.D., Ph.D.
Copyright � 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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