The Pathogenesis of Prostate Cancer

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Toby BJ Murray, MD, MSC, MSCR


Prostate cancer is a major cause of pathology in men world-wide and is age-related. Rare in the under 40s, a third of all those over 80 have been shown to have prostate lesions at autopsy. Both hereditary and molecular influences appear to be involved in the pathogenesis of the condition. Androgenic receptors play a major role in most, but not all, prostate cancers. The cell type involved is related to the aggressiveness of the malignancy. Of those that develop the disease, some die with prostate cancer, others because of it. Over 90% of the cancers are adenocarcinomas. The likelihood of progression of the disease can, but only to a degree, be predicted on histological examination, according to the Gleason Scale and its modifications. These assess degrees of tissue differentiation. Use of blood levels of prostate specific antigen levels as an indication of the activity of tumors is also not straightforward. Our understanding of the disease mechanisms needs further expansion if we are to advance diagnosis of aggressive tumors and develop more effective therapies.


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Chapter 3