الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Prostate cancer is the second most common cancer in men worldwide. It is now the second leading cause of death in men exceeded by only lung cancer. In Egypt prostate cancer is the most common male genital system cancer. Prostate cancer is uncommonly seen in men younger than 50 years; the incidence rises rapidly with each decade thereafter. The incidence rate is higher in African American men than in white men. Men with a family history of prostate cancer are at an increased risk of the disease compared with men without this history. Other potential risk factors of prostate cancer include alcohol consumption, vitamin or mineral interactions and other dietary habits.
Adenocarcinomas account for about 95% of prostate cancers. The Gleason system is the most widely used grading system for prostate cancer. Most men with early stage have no symptoms attributable to the cancer. Urinary frequency, difficulty, urgency and nocturia are seen commonly but are usually related to a concomitant benign prostate enlargement. Bone pain may be the presenting symptom in men with metastatic disease.
Serum PSA, DRE and transrectal ultrasonography constitute the three major diagnostic means for the detection of this cancer. A combination of information about the extent of the primary tumor (T), lymph node (N) involvement, and presence or absence of distant metastases (M) with the Gleason score of the primary tumor and the serum PSA level are used to classify men according to their risk of recurrence.
Treatment strategy is defined according to initial PSA, stage and grade of the disease and to the age and general condition of the patient. Active surveillance, surgery and radiotherapy with or without hormone-therapy, are appropriate choices for localized disease. Hormonal therapy plus radiotherapy is considered treatment of choice for locally advanced disease. In metastatic disease, ablative hormone therapy is the mainstay of treatment while chemotherapy is evaluated in hormone refractory patients.
Our study collected data from the medical records of 426 prostate cancer patients presented to Alexandria Clinical Oncology Department from January 2000 to December 2009. All pathologically proven prostate cancer cases were included. Follow up ranged from 2 months up to 148 months.
Age ranged from 46 to 86 years with mean age of 69.99 years and median age of 70 years. The most common presenting symptom was found to be frequency of micturition in 39% of the patients, followed by dysuria in 37.1 %.
The most common pathological type of prostate cancer was adenocarcinoma in 92.3 % followed by transitional cell carcinoma reported in 2.1%. PSA values of >20ng/ml were the highest ranging 34.3% while values ≥10 - <20/ml were the second highest with a percentage of 31.5%. In the study, Gleason score greater than 7 was the most common with a value of 39.2% while score of 7 was the second most common constituting 21.6% of patients.
The most common T stage was T2 with a percentage of 36.9% and the second most common was T3 with a percentage of 25.1% of patients. Positive lymph nodes were encountered in 15% of the study population. There percentage of patients who presented with distant metastasis was 29.6%, the most common site for metastasis was bone in 89.7 % of the patients, followed by lung metastasis in 10.3%.
In this study localized prostate cancer patients constitute 62.9% of the cases. The most common risk group within patients with localized disease was found to be intermediate risk group, representing 34%. Patients with metastatic disease formed 29.6% of the cases.
In localized prostate cancer, only 7.8% of patients have undergone radical prostatectomy. EBRT with or without hormonal therapy was delivered to 82.1% of patients, while only 11.6% of patients received hormonal therapy alone. In metastatic patients, orchiectomy was carried out in 34.9%, while ADT was delivered to 32.6% of patients. Palliative irradiation was given in 79.4%.