ABSTRACT
Prostate cancer arises from glandular epithelium, most often in the peripheral zone of the prostate. Prostatic intraepithelial neoplasia (PIN) is also often found in the peripheral zone, and is believed to be a premalignant stage of, although not a prerequisite for, prostate carcinoma.1 A special feature for prostate cancer is that a latent form of the disease is very common. Microscopic lesions of cancer have been found in autopsies from more than 50% of men between 70 and 80 years old.2 A vast majority of these histologic cancers would most probably never develop into a clinical cancer. Whether these incidentally found small carcinomas represent the same disease entity as the clinically relevant, life-threatening tumors, is not really known.3 Prostate cancer progression is a multistep process, in which an organ-confined tumor eventually invades through the capsule of the prostate into its surroundings and metastasizes to local lymph nodes and to distant organs, mainly bones (Figure 23.1). The growth and progression of prostate cancer is dependent on androgens. Therefore, the standard treatment for advanced prostate cancer has, for more than half a century, been hormonal therapy, such as castration or antiandrogens. However, during the treatment, an androgen-independent cancer cell population will eventually arise.4 For such hormonerefractory tumors, no effective treatments are available.
