Session IV: Prostate Prostate cancer and imaging

Prostate cancer’s incidence, prevalence, etiology, and risk factors, and the influence of clinical trials on imaging technology development are discussed. One in seven Western men older than 70 will develop prostate cancer. The advent of prostate-specific antigen (PSA) screening means most men will now be diagnosed with early disease (85% not palpable on digital rectal exam (DRE), fewer grade 8–10 Gleason score tumors, etc.). An infection/inflammation event may be the basis for transforming events within the prostate, perhaps driven by an infectious agent or by dietary or environmental exposure to oxidative stress-producing substances which can cause chronic carcinogenic inflammatory infiltrates. A number of prostate cancer susceptibility genes control or regulate pathways associated with cellular defense; intervention with protective agents such as NSAIDs or free-radical scavenging drugs hold promise for localized disease control or treatment. Managing more advanced extraglandular disease remains problematic, as does biochemical failure after radical prostatectomy or external beam radiation; imaging disease stage and progression associated with these distinct classes of cases is challenging. Fundamental data soon to be available from large screening trials (e.g., European Organization of Research and Treatment of Cancer, or Prostate, Lung, Colorectal, and Ovarian Cancer Trial), and implications for prevention science from recent studies of hormone antagonists such as finasteride in the Prostate Cancer Prevention Trial or toremifene, should stimulate new ways of thinking about treatment and diagnosis in urology and imaging communities. Prostate atrophy, inflammation, and dietary charred meat carcinogens in prostate carcinogenesis