Recent advances in early prostatic cancer

Early prostatic carcinoma is a slowly progressing, localized malignant tumo r which has been recently discovered with increased frequency due to the us e of improved diagnostic methods. The combination of digital rectal examina tion, serum PSA level and transrectal ultrasound is currently the best avai lable diagnostic tool, although other putative diagnostic markers and techn iques are being investigated. Core needle biopsy may follow if there is sus picion of malignancy and in doubtful cases the most useful antibody for the immunohistochemical diagnosis of early, low grade prostatic carcinoma is c lone 34 beta E12. Cytogenetic techniques and molecular biological methods a re increasingly being used for further investigating localized prostate car cinomas in ol-der to identify early molecular targets and alterations, whic h may lead to progression. Chromosome abnormalities, cell to cell and cell to matrix interactions changes in the status of steroid hormone receptors, oncogenes and tumor suppressor genes, as,well as other as yet unclear event s may be of importance in prostate carcinogenesis and the progression of ea rly malignant tumors to aggressive phenotypes. A variety of putative progno stic markers, apart from serum PSA levels, histological grade and tumor vol ume such as neuroendocrine differentiation, angiogenesis, cell proliferatio n labeling index and ploidy analysis may prove useful in evaluating tumor p rogression in early prostatic carcinomas. The final and most important goal of all investigations related to early prostate cancer is to contribute to the best therapeutic management of the individual patient.