Pre-malignant disease in the prostate

Carcinoma of the prostate (CaP) is the most common non-cutaneous cancer in men and the second most common cause of cancer related death. Mortality remains high despite improvements in diagnosis in the developed world. A better understanding of the mechanisms involved in the development of prostate cancer should allow targeted diagnosis, prevention and treatment, and may improve mortality. In this chapter, we outline the two principal pre-malignant histological types, prostate intraepithelial neoplasia (PIN) and atypical small acinar proliferation (ASAP) and the likelihood of progression to CaP if these diagnoses are made. We then assess current understanding of factors contributing to the initiation of pre-malignant disease and progression to CaP as they relate to stem cells, inflammation, diet and specific genetic mutations or aberrant pathways. Finally, we discuss the translational potential of these factors in early detection and prevention of CaP.