Gå direkt till huvudinnehållet

Prostatacancer

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition:
Som regel adenokarcinom. Ökad risk för tillståndet vid ärftlig faktor, hög ålder.
Förekomst:
Prostatacancer är den vanligaste cancersjukdomen i Sverige med omkring 10 000 nya fall per år.
Symtom:
Symtom kan saknas. Vid mer avancerad sjukdom ofta blåstömningssymtom, tilltagande skelettsmärtor och skelettmetastaser utan känd primärtumör. Välgrundad misstanke enligt standardiserat vårdförlopp, se kortversion för primärvården (RCC) .
Kliniska fynd:
I de tidiga stadierna ofta avsaknad av kliniska fynd. Vid mer avancerad sjukdom palperas prostatan med hård och eventuellt varierande konsistens och ojämn yta.
Diagnostik:
PSA-test är lämplig vid specifik misstanke, inte som screeningundersökning. Vid höga PSA-värden rekommenderas MRT så att biopsier därefter selektivt kan riktas mot eventuella tumörmisstänkta områden.
Behandling:
Patient- och tumörspecifika förhållanden avgör behovet av behandling. Behandlingsalternativ är aktiv monitorering, kirurgi, hormonbehandling, strålbehandling, brakyterapi, kryoterapi och cytostatika.
  1. Prostatacancer. Nationellt vårdprogram. Regionala cancercentrum i samverkan (hämtad 2023-10-19) cancercentrum.se  
  2. Lichtenstein P, Holm NV, Verkasalo PK, et al. Environmental and heritable factors in the causation of cancer -- analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med 2000;343:78-85. PMID: 10891514 PubMed  
  3. Chazelas E, Pierre F, Druesne-Pecollo N, et al. Nitrites and nitrates from food additives and natural sources and cancer risk: results from the NutriNet-Santé cohort. Int J Epidemiol 2022. pmid:35303088 PubMed  
  4. Selly S, Donovan J, Faulkner A, Coast J, Gillatt D. Diagnosis, management and screening of early localised prostate cancer. Health Technol Assess 1997; 1: 1-96. PubMed  
  5. Coley CM, Barry MJ, Fleming C, Mulley AG. Early detection of prostate cancer part 1: Prior probability and effectiveness of tests. Ann Intern Med 1997; 126: 394-406. PMID: 9054286 PubMed  
  6. Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: A review of the evidence for the US Preventive Services Task Force. Ann Intern Med 2011; 155: 762-71. PMID: 21984740 PubMed  
  7. American Urological Association (AUA) Guideline. Early detection of prostate cancer: AUA guideline. 2013. www.auanet.org  
  8. Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014 doi: 10.1016/S0140-6736(14)60525-0 DOI  
  9. Nordström T, Akre O, Aly M et al. Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer. Prostate Cancer Prostatic Dis. 2018;21(1):57–63. PMID: 29259293 PubMed  
  10. Ploussard G, de la Taille A. The role of prostate cancer antigen 3 (PCA3) in prostate cancer detection. Expert Rev Anticancer Ther. 2018;18(10):1013–1020. PMID: 30016891 PubMed  
  11. Dolejsova O, Kucera R, Fuchsova R, et al. The Ability of Prostate Health Index (PHI) to Predict Gleason Score in Patients With Prostate Cancer and Discriminate Patients Between Gleason Score 6 and Gleason Score Higher Than 6-A Study on 320 Patients After Radical Prostatectomy. Technol Cancer Res Treat. 2018;17:1533033818787377. PMID: 30021484 PubMed  
  12. Olleik G, Kassouf W, Aprikian A, et al. Evaluation of New Tests and Interventions for Prostate Cancer Management: A Systematic Review. J Natl Compr Canc Netw. 2018;16(11):1340–1351. PMID: 30442734 PubMed  
  13. Wallström J, Geterud K, Kohestani K, Maier SE, Pihl CG, Socratous A, Stranne J, Arnsrud-Godtman R, Månsson M, Hellström M, Hugosson J. Prostate Cancer Screening with Magnetic Resonance Imaging: Results from the Second Round of the Göteborg Prostate Cancer Screening 2 Trial. Eur Urol Oncol. 2022 Feb;5(1):54-60. doi: 10.1016/j.euo.2021.09.001. Epub 2021 Sep 25. PMID: 34580053 PubMed  
  14. Socialstyrelsen (2014): Prostatacancer, screening med PSA-prov. www.socialstyrelsen.se  
  15. Khatami A, Damber JE, Lodding P et al. Does initial surveillance in early prostate cancer reduce the chance of cure by radical prostatectomy? A case control study. Scand J Urol Nephrol 2003; 37: 213-7. PubMed  
  16. Klotz L. Active surveillance with selective delayed intervention using PSA doubling time for good risk prostate cancer. Eur Urol 2005; 47: 16-21. PubMed  
  17. Kenfield SA, Stampfer MJ, Giovannucci E, Chan JM. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. J Clin Oncol 2011; 29: 726-32. PubMed  
  18. Bonn SE, Sjölander A, Lagerros YT, Physical activity and survival among men diagnosed with prostate cancer. Cancer Epidemiol Biomarkers Prev. 2015 Jan;24(1):57-64. PMID: 25527697. PubMed  
  19. Klein EA, Thompson IM Jr, Tangen CM, et al. Vitamin E and the risk of prostate cancer: the selenium and vitamin E cancer prevention trial (SELECT) . JAMA 2011; 306: 1549-56. PMID: 21990298 PubMed  
  20. Smith DP, King MT, Egger S, et al. Quality of life threee years after diagnosis of localized prostate cancer: population based cohort study. BMJ 2009; 339: b4817. PMID: 19945997 PubMed  
  21. Comiter C. Surgery for postprostatectomy incontinence: which procedure for which patient?. Nat Rev Urol. 2015; 12(2): 91-9. pmid:25558839 PubMed  
  22. Johansson E, Steineck G, Holmberg L, et al. Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial. Lancet Oncol 2011; 12: 891-9. PubMed  
  23. Anderson CA, Omar MI, Campbell SE, et al. Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Syst Rev 2015; 1: CD001843. doi:10.1002/14651858.CD001843.pub5 DOI  
  24. Potosky AL, Davis WW, Hoffman RM, et al. Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study. J Natl Cancer Inst 2004; 96: 1358-67. PubMed  
  25. Wallis CJD, Mahar AL, Choo R, et al. Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis. BMJ 2016; 352: i851. doi:10.1136/bmj.i851 DOI  
  26. Bagshaw HP, Arnow KD, Trickey AW et al. Assessment of Second Primary Cancer Risk Among Men Receiving Primary Radiotherapy vs Surgery for the Treatment of Prostate Cancer. JAMA Netw Open. 2022 Jul 1;5(7):e2223025. PMID: 35900763. PubMed  
  27. Nead KT, Gaskin G, Chester C, et al. Association between androgen deprivation therapy and risk of dementia. JAMA Oncol. Published online October 13, 2016 . doi:10.1001/jamaoncol.2016.3662 DOI  
  28. Jayadevappa R, Chhatre S, Malkowicz B, et al. Association Between Androgen Deprivation Therapy Use and Diagnosis of Dementia in Men With Prostate Cancer. JAMA Netw Open 2019; 2: e196562. pmid:31268539 PubMed  
  29. Baik SH, Kury FSP, McDonald CJ. Risk of Alzheimer's Disease Among Senior Medicare Beneficiaries Treated With Androgen Deprivation Therapy for Prostate Cancer. J Clin Oncol. 2017. PMID: 28841388 PubMed  
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet