Once again the case for and against prostate cancer screening was discussed. There is concern that in highly screened populations over-detection of prostate cancer is occurring with subsequent over treatment. This is particularly the case when PSA "cut-offs" of <4 are used. This concern is balanced by the knowledge that younger men with high grade disease do benefit from early detection and intervention.

Hugosson Jetal ., Eur Urol 2006 calculated the cumulative risk of being diagnosed with prostate cancer by PSA screening as follows;

PSA Level ng/ml	Within 7 yrs
<.5	0%
0.5-1.0	0 .8%
1-1.5	4.8%
1.5-2.0	12.6%
>2.0	>20%

Hugosson recommends re-screening every year for initial PSA>1.5 whilst decreasing screening to third yearly for PSA <1.5. It is likely that the fields of genomics and proteomics will develop markers that are prostate cancer specific and will be predictive of the biological potential of the individual prostate cancer. In the mean time "active surveillance" (not watchful waiting) should be offered to men with low volume prostate cancer.

Dr Eric Klein delivered the American Urological Association lecture to the EAU Congress. Based on collaborative work in the US he postulated that certain men have a mutation of the HPC1 gene. This mutation prevents these men from producing an anti viral protein called RNasel which renders them susceptible to infection by a certain retro virus. This retro-virus which may cause prostate cancer has been isolated consistently in the prostates of men with prostate cancer, these men also having the HPC1 mutation.

This work may lead to the development of a vaccine against prostate cancer for use in susceptible men. This is a concept currently being trialled with respect to human papilloma virus and cervical cancer.

The debate continues as to whether radical prostatectomy should be performed with open surgery, laparoscopic surgery or robot assisted laparoscopic surgery. The Europeans have developed wrist activated instruments that give a similar range of movement as the robotic technique. They are combining the use of these instruments with a 3-D facial visor that the surgeon wears whilst operating.

Review of data from centres championing each of these techniques fails to show any advantage of one technique over another with respect to the goals of surgery which are cure of the cancer with preservation of continence and potency.

This novel "low impact" therapy was presented at an industry sponsored symposium. The principle is to target the vasculature of cancers by injecting a photo-sensitising chemical (bacterio-chlorophyll). This binds to the blood supply of the prostate cancer and is activated by a light probe that is inserted into the prostate gland. Cytotoxic or reactive oxygen molecules are formed which trigger cell destruction.

It is thought that this technique may be suitable for men with low volume prostate cancer on active surveillance programs. Re-treatments are possible with minimal morbidity. We will observe the clinical trials with interest.