الفهرس 
Overview of localized prostate cancerOnly 14 pages are availabe for public view
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Abstract
Globally, prostate cancer (PCa) is highly prevalent. It is the second most common tumor in men worldwide.
However, there exists a substantial worldwide variation in disease incidence and mortality because of genetic background, life style factors, screening programs, and available treatments.
During the last several decades, significant improvements have been achieved in PCa treatments that have helped to decrease PCa mortality, especially in early-stage disease. In the United States, more than 90% of PCa is diagnosed in early stages (i.e., at local or regional stages) for which the 5-year relative survival rate approaches 100%. However, when it has already metastasized by the time of diagnosis, the 5-year survival rate has been as low as 32%. Over the past 25 years, the 5-year relative survival rate for all stages combined has increased from 68.3% to 99%.
Brachytherapy is appealing to older men that are not physically able to withstand a complicated surgical prostatectomy, as well as for younger men that wish to maintain a normal life-style. With the development of computer-based planning and improvement of the implantation procedure, brachytherapy has shown to produce comparable outcomes to the other modalities, with a decrease in gastrointestinal and variable genitourinary complication compared to external beam radiation.
Recent technological advances in HDR brachytherapy have increased the appeal and application of this approach for patients with localized prostate cancer. Current treatment methods allow optimization of dose distribution thus administering a high dose of radiation thattightly conforms to the targeted volume, which may open the door for dose escalation studies and allow better coverage of extraprostatic disease in higher risk disease that was not previously feasible, therefore, improving therapeutic outcome while minimizing radiation exposure to adjacent healthy organs further minimizing the adverse events. Also, it shows favorable toxicity profiles and potency preservation compared to LDR.
Ongoing clinical studies are investigating the feasibility of performing a single implantation, during which only one treatment is administered. This approach would reduce health care costs and medical personnel workload, and it would likely improve patient comfort and convenience. However, several issues regarding HDR brachytherapy remain to be adequately addressed. The ideal radiation dose and number of fractions are not yet known because direct comparisons between various treatment regimens are lacking. Randomized clinical trials are needed to directly compare HDR brachytherapy with other forms of treatment for prostate cancer,particularly LDR brachytherapy and external-beam RT. Randomized clinical trials are also needed to determine whether androgen suppression should be integrated into the overall treatment strategy for some patients.
In our study, we found that stage IV accounts 76.4% of all included patients that presented to oncology department in Ain shams University Hospitals in the period between 2006 and 2012.
As regards risk stratification of the patients, we found that 1.8 % of patients was categorized in the low risk group, 12.7% in the intermediate risk group and 85.5 % in the high risk group which was the largest percent. This is may be due to lack of awareness among patients who presented with advanced disease. Also, it may results from presentation of early diagnosed patients to the Urology Department which leads to limitation of the early role of brachytherapy in treatment of patients presented to us.