Timo Soeterik

10 CHAPTER 1 PROSTATE CANCER Prostate cancer: the importance of accurate staging Patients with newly diagnosed prostate cancer are confronted with a disease that can present itself in a wide heterogeneity of forms. Initial presentation can vary from indolent cancer with very limited impact on life expectancy without need for immediate treatment, to subtypes that are characterized by rapid progression with potential lethal outcome, demanding a timely and invasive treatment strategy. The more accurately the aggressiveness and stage of disease are characterized at diagnosis, the higher the likelihood of selecting the treatment option providing the best value in terms of oncological and health-related quality of life outcomes. Accurate staging of prostate cancer can be established by combining the most relevant baseline characteristics and by incorporating those into risk classification systems and prediction tools, enabling personalized treatment advice. Given the developments in the field of medical imaging (e.g. magnetic resonance imaging [MRI]), regular validation and updates of these tools and classification systems are essential to ensure prognostication and choice of treatment are done as accurate as possible given the current state of knowledge. Prostate cancer epidemiology Prostate cancer is a very common disease and is currently the second most frequently diagnosed cancer and third most common cause of cancer death among males worldwide. In 2019, a total of 13557 new diagnoses and 2896 prostate cancer-related deaths were reported in the Netherlands. 1 Taking into account expected population growth and aging, incidence is expected to increase between 40 and 60% in 2040. 2 Of all newly diagnosed Dutch patients, approximately 65% are affected with prostate cancer that is limited to the prostate. 1 Another 20% of the patients are diagnosed with locally advanced cancer (extension of the disease outside the prostate capsule and/or metastasis limited to the pelvic lymph nodes), whereas 15% constitutes of patients with distant metastasis (distant lymph node, bone and/or visceral metastasis). 1 History of prognostic factors established at initial diagnosis Several clinical, biochemical and histological characteristics found at initial diagnosis of prostate cancer have been evaluated as potential factors providing information regarding the expected disease course. Currently, the most established factors include clinical stage of the tumour (cT), serum prostate-specific antigen (PSA) level at diagnosis and highest Gleason score found on prostate biopsy.