**7. Conclusion**

Future of prostate biopsy will be interesting, a lot of new ideas and technologies are competing at present and it remains open which will, in the end, dominate the market and our every-day practice.

Although new targeted technologies, either ultrasound or magnetic resonance, may improve detection and sampling and reduce need for increasing number of cores and repeat biopsy sessions, none seem at present nearing 100% sensitivity or specificity. At present, approximately 50% positive biopsy rate is expected in repeat biopsy setting using either C-TRUS ANNA or MRI-guided or MRI-US picture fusion guided biopsy.

As burden of biopsies may increase dramatically in the near future (as explained above - (Quon et al., 2011)) further increases in complexity and technological demands may not be able to satisfy mass biopsy needs. Prostate biopsy is not very demanding procedure, potential harms and problems for patients do exist, but are not nearly as large as for different forms of prostate cancer treatments. Therefore, such a breakthrough as happened

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**Part 2** 

**Surgical Treatment Options** 


**Part 2** 

**Surgical Treatment Options** 

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**6** 

*Spain* 

**Radical Prostatectomy in** 

**High Risk Prostate Cancer**

Jorge Rioja, Carlos Blanco and Jorge Aranda

*Dept Urology, University Hospital Miguel Servet, Zaragoza* 

Prostate cancer is the leading cancer diagnosis in men, and the second cuase, after lung cancer, of cancer death in men in the U.S. Worldwide is the fourth most common cancer in men with variable incidence and mortality rates, based on geographic regions (1). In Europe is the most common solid tumor, with an incidence of 214 cases per 1000 men, outnumbering the lung and colorectal cancers, and is the second most common cause of

In recent years, the incidence of prostate cancer is increasing in most countries due to the improvement and widespread use of PSA, aging and probably a real increase in incidence. In men after 40 years there is a progressively incidence increase, with a peak at age 80. The countries with the highest mortality rate for prostate cancer are: Switzerland, Scandinavia and the USA-adjusted death rates by age group between 15-20/100.000 inhabitants. By contrast, the Asian countries with Japan and China leading the way, have the lowest

The geographic incidence variations of prostate Cancer are multiple and complex, but there are genetic and environmental factors, which seem to be more involved in its genesis. African Americans are those who have higher rates of prostate ca. As mentioned above, China and Japan have lower rates in the incidence of prostate ca and USA one of the highest in the world, well, it is noteworthy that Asian Americans have lower incidence rate of prostate cancer than white Americans, the indicating that the genetic factor is crucial in the

The overall increase in the incidence of prostate cancer worldwide in recent decades, is justified with the development of PSA screening protocols of prostate Cancer. The diagnosis of prostate cancer is based on the determination of serum PSA. The risk of prostate cancer is

> PSA 0-2 ng / ml: 15-25%. PSA 2-4 ng / ml: 17-32% PSA 4-10 ng / ml: 17-32% PSA> 10 ng / ml: 43-65%.

There is still much controversy among health professionals about what is the best protocol for the screening of prostate cancer. The long awaited results of two prospective, randomised trials were published in 2009. The Prostate, Lung, Colorectal, and Ovarian

**1. Introduction** 

cancer death in men.

development of the disease.

depending on Serum PSA (2):

mortality rate (less than 5 per 100,000 population) (1).
