Epidemiology, diagnosis and prognosis of localized prostate cancer: What's new?

Detection and diagnosis of prostate cancer has challenged researchers and clinicians for several years, particularly with the increase of its incidence. With the advent of optimal treatments for each patient, diagnosis and prognostic toots arouse more and more interest. Effectively, it becomes necessary to assess even better the aggressiveness of the tumour in order to choose the most appropriate treatment and, thus to make a correlation between the phenotype and the genotype. The biological screening relies on PSA alone currently but should know another era soon with the advent of new markers, such as urinary gene PCA3, usefull for patients with previous negative biopsies. The techniques of biopsies and medical imaging are also going through multiple changes and evolutions that are about to increase their reliability. The optimization of MRI allows more precise diagnosis of local invasion and is usefull to optimize. Finally, the emergence of biological prognostic markers, such as endothelin or semaphorin 3A, whose expressions differ according to the type of cancer, should help to predict disease's gravity and outcome. The comprehension and the understanding of carcinogenesis pathways leads to new perspectives for targeted and earlier cancer therapies. (C) 2009 Elsevier Masson SAS. All rights reserved.