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prostate cancer is an important cause of morbidity and mortality in human pathology . in recent years , in the western countries is increasing the number of people affected by this disease , which can be partly explained by the longer lifetime of patients , application of modern methods of screening and better health education .
however , the incidence and mortality of this disease also suggest the influence of other factors . the incidence of prostate cancer shows large variations from 130/100,000 ( african - american population in the united states ) to less than 10/100,000 men annually ( far east ) ( 1 ) .
the total population of the una - sana canton is about 300,000 , and the ratio of men to women is 50:50 , so therefore the incidence of prostate cancer in our canton is around 23/100,000 men annually . according to the literature
, the obviously largest number of patients is in the age group from 65 - 75 years ( 2 ) .
the true prevalence of prostate cancer is difficult to determine , but it can be said that it is in third place by occurrence in men .
accordingly , variations in terms of incidence , and mortality from this disease varies from high ( u.s . ) to a low in the countries of the far east , as indicated by earlier statistical analyses ( 3 ) .
cancer is a disease caused due to genetic ( or inherited ) mutations , in conjunction with other factors , in the framework of complex and poorly understood mechanisms .
it is known that some of these mechanisms are relevant to carcinogenesis : a ) activation of oncogenes ; b ) suppression of tumor growth by inhibitor gene ; c ) to cancer development also contributes the impact of risk factors .
risk factors by themselves do not cause disease , but can contribute to an increased risk of its occurrence .
some of those are , in this case , age , racial origin , familial tendency , hormonal influences , diet .
histological analysis showed that in 95 % of cases of prostate cancer is detected adenocarcinoma originated from epithelial cells and gland secretory tubules .
the remaining 5 % of cases involved , transitional , planocellular and neuroendocrine carcinoma . for histological diagnosis of prostate cancer is necessary that it comply with several criteria .
first of all , necessary is the presence of cellular atypia , which refers to a bizarre set of cells , then a change in the relationship between the nucleus and cytoplasm , disrupted prostate lobular architecture , and change in the intensity of staining .
one of the important features of cancer is invasive growth , in this case the tendency of penetration outside the capsule of the prostate and spreading to surrounding structures , with possible distant metastases , which is the essential characteristic of malignancy .
determination of malignancy degree is the basis for a selection of therapeutic approach and prognosis .
the predominant histological picture is designated the third group with psa of 4 - 10 ng / ml ( 12 patients ) , a fourth as primary and secondary as a minor .
group with psa 10 - 20 ng / ml ( 15 patients ) , the fifth group with summing up produces a value of gleason score .
the higher the psa 20 - 50 ng / ml ( 9 patients ) and the last group of patients with gleason score is the greater is the degree of malignancy ( 5 ) .
as noted above , the increase in number of new cases of prostate cancer in recent years can be partly explained by advances in diagnosis .
three indispensable tests in the diagnosis of prostate cancer are : a ) digito - rectal examination , simple and affordable test , but insufficiently specific and needs to be supplemented with the remaining two tests ; b ) ultrasound of the prostate and c ) analysis of serum prostate specific antigen ( psa ) .
it is not a tumor marker because its value can be increased with the other , benign prostate diseases , although it is responsible for the detection of a large number of prostate cancer in less advanced stages .
generally is accepted value of 4 ng / ml as the upper limit , although in rare cases the cancer can be present even if the psa levels are below 4 ng / ml ( 6 ) .
in addition , determined is the ratio between free and total psa ( f / t psa ) , which also has prognostic significance , since the value below 0.20 speaks in favor of malignancy and higher values indicate other , more benign prostate disease . in case of doubt on prostate cancer ,
since the introduction of this diagnostic procedure until now , the method is well advanced .
today the standard method is transrectal prostate biopsy with biopsy gun guided by transrectal ultrasound ( 7 ) .
treatment of patients with prostate cancer depends on the stage of the disease at the time of detection and the expected duration of the patient s life due to associated diseases .
therapeutic options are active monitoring of the patients , radical prostatectomy , radical radiotherapy , complete androgen blockade ( chemical or surgical ) .
with this research we wanted to show the number of patients treated for prostate cancer in bihac cantonal hospital , in correlation with diagnostic parameters .
by retrospective study we analyzed hospital records ( history of the disease , outpatient and surgical protocols ) of patients diagnosed with prostate cancer .
patients were subjected to the usual diagnostic protocol : clinical urological examination , transabdominal ultrasound with a multi frequency probe of 3.5 - 5 mhz , laboratory tests ( psa , f / t psa ) , prostate biopsy and additional imaging diagnostic procedures in selected patients .
retrospective analysis of hospital records , for a period of two years , identified 70 patients in who by the use of the usual diagnostic protocol was diagnosed prostate cancer .
each patient had at least one measured serum psa values , with a large variation in findings , from 1.6 ng / ml to 3332 ng/ ml .
the lowest value was 0.02 and the highest 0.627 ( average f / t psa = 0.13 ) patients , on the basis of the psa value were divided into groups : first group , patients with psa value up to 2.5 ng / ml ( 1 patient ) , the second group psa 2.5 - 4 ng / ml ( 3 patients ) , the third group with psa of 4 - 10 ng / ml ( 12 patients ) , a fourth group with psa 10 - 20 ng / ml ( 15 patients ) , the fifth group with psa 20 - 50 ng / ml ( 9 patients ) and the last group of patients with psa above 50 ng / ml ( 30 patients ) .
it is done taking into account the results of previously conducted diagnostic procedures and set up clinical suspicion on prostate cancer .
correlation of psa values and biopsy finding correlation of psa values and cancer stage among patients that underwent biopsy depending on the results of the diagnostic tests , the patients were subjected to an appropriate therapeutic protocol . in that sense 26
patients underwent radical prostatectomy , 41 patients underwent palliative orchiectomy , also performed are 3 transurethral resections of the prostate with orchiectomy .
prostate cancer has undoubtedly great importance in the general population , due to the fact that it is the most common malignant tumor in men aged over 65 years .
results of this study showed that the majority of patients diagnosed with prostate cancer are aged over 60 years .
there is the need for the introduction of a planned treatment of prostate cancer , given the expected longer life span of patients in the future , and therefore , the expected increase in the number of patients .
there were discussions about treatment options , once the diagnosis of cancer has already been set .
best prognosis , with the possibility of complete cure has patients with localized disease , the value of psa under 20 ng / ml , and life expectancy for at least another 10 years .
most of the patients were subjected to a method of palliative , indicating a late diagnosis . in recent years
while it is generally accepted value of 4 ng / ml as the upper limit , malignant process at lower values is not excluded . in our study , we had a patient with prostate cancer and a psa value of 1.6 ng / ml . however , from our study of 70 patients , 30 of them had a psa value above 50 ng / ml at the time of reporting to the doctor .
another 36 patients had psa in the range from 10 to 50 ng / ml .
thus , a larger number of patients , according to the psa at time of diagnosis , had already advanced tumor process .
generally , psa correlate well with malignant diseases of the prostate , as evidenced by the results of our research . in the world
already exist an initiative to introduce the psa screening for prostate cancer as routine analysis for all patients aged over 50 years , and even below the age of 50 , when there is family history or person belongs to a population that is often affected by this disease ( african americans ) ( 8) . in denmark psa screening on prostate cancer is recommended for men with at least two close relatives diagnosed with prostate cancer ( 9 ) .
there are other proposals that psa testing , in the form of screening , should be selectively applied to a selected population , i.e. one that is at higher risk of developing prostate cancer ( 10 , 11 , 12 ) . regarding this ,
specifically , the elevated values of psa are not necessarily related to the malignant process .
they can be found in other , benign diseases of the prostate ( benign prostatic hyperplasia ) , urinary tract infection , after prostate biopsy .
also , we should take into account the effect of drugs such as dutesteride or finasteride , which lowers the psa value and are used for benign prostatic hyperplasia , which can ultimately disguise the malignant process .
in addition , there is a fear of  over diagnosis  of prostate tumors and exposure of many patients , too often unnecessary procedures , which entails the potential side effects such as urinary incontinence , erectile dysfunction , infection .
in fact , according to some studies , only 25% of patients undergoing prostate biopsy had confirmed malignant process ( 13 ) . according to some authors ,
psa testing should be voluntary , once to the patient is provided insight into the good and bad sides of the tests ( 14 ) .
there are also suggestions that men with the expected longer life span have a greater potential benefit from being subjected to psa testing ( 15 ) .
however , by examining the results of our study , it can be seen a good correlation between psa and extent of tumor process .
bearing in mind that nearly half of the patients had a psa over 50 , there is no doubt that with the test for prostate cancer in men over 50 years , certainly many of these people will earlier came to a urologist , which would ultimately affect the success of the therapy and certainly the prognosis in these patients .
regardless of the results of large studies , such as the plco ( prostate , lung , colorectal , ovary ) and indications that the incidence of prostate cancer is higher in men who underwent annual screening , but that mortality is the same as in the control group ( 16 ) , in our conditions an analysis of psa in men over 50 years would certainly gave favorable results .
after all , a european study of screening for prostate cancer , and some studies in the united states , pointed to a lower mortality rate compared to the control group ( 17 , 18 ) .
retrospective analysis of medical documents of patients treated due to the prostate cancer in the bihac cantonal hospital , over a two year period , we concluded that common diagnostic and therapeutic protocols were applied . for a successful therapeutic approach and a good prognosis ,
psa value can be regarded as a reliable diagnostic marker for early detection of this disease .
introduction : prostate cancer is an important cause of morbidity and mortality in human pathology . in recent years there has been an increase in the number of new cases.material and methods : in this article , we want to show the number of patients diagnosed and treated due to prostate cancer in the cantonal hospital bihac , bosnia and herzegovina , over a two year period . after examining the medical records , we selected 70 patients diagnosed with prostate cancer . 
 average age was 70.9 years ( 51 - 91 years ) . 
 the total psa ranged from 1.6 to 3332 ng / ml . for each patient 
 is determined the psa ratio f / t psa , with an average value of 0.13 ( 0.02 to 0.627).results : from the data analysis , we concluded that nearly half of the patients ( 30 patients ) , came to the urology clinic with advanced disease . 
 the stage of the disease is well correlated with psa value.conclusion:the psa can be considered as a reliable marker in the diagnosis and treatment of prostate cancer . 
 regardless of the current controversy on the issue of screening on prostate cancer using the psa analysis , we believe that the use of this simple test in selected populations is justified for the purpose of early disease detection .