Prostate Cancer
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More InDepth Information on This Condition

Definition
Prostate cancer is a disease in which cancer cells grow in the prostate gland. The prostate is a walnut-sized gland in men. It surrounds the urethra. The prostate makes a fluid that is part of semen.

Prostate Cancer

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The sooner prostate cancer is treated, the better the outcome.

Causes
Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but it is probably a combination of genetics and environment.

Risk Factors
Prostate cancer is more common in men who are aged 55 years and older. It is also more common in black men than white men. Other factors that may increase your chance of prostate cancer include:

  • Family history of prostate cancer, especially father or brother
  • Family history of prostate cancer diagnosed at a young age
  • A high-fat diet
Symptoms
Prostate cancer may cause:

  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Not able to urinate
  • Weak or interrupted urine flow
  • Painful or burning urination
  • Difficulty having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in the lower back, hips, or upper thighs
These symptoms may be caused by other conditions, such as benign prostatic hyperplasia (BPH) or an infection. If you have any of these symptoms, promptly see your doctor.

Diagnosis
Your doctor will ask about symptoms and medical history. A physical exam will also be done.

Tests may include:

  • Digital rectal exam
  • Blood tests
  • Urine tests
Imaging tests evaluate the prostate and surrounding structures. These may include:

The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, prostate cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.

Treatment
Cancer treatment varies depending on the stage of prostate cancer. You and your doctor will discuss the best treatment options for you. Treatment may include:

Watchful Waiting
This involves your doctor monitoring the cancer to see if it is growing. Watchful waiting may be appropriate if you:

  • Have early stage prostate cancer that is growing slowly
  • Are of an advanced age
  • Have serious health problems (risks of treatment outweigh the benefits)
Surgery
Types of surgery that may be needed include:

Since prostate cancer surgery may cause side effects, like erectile dysfunction, urinary incontinence, and fecal incontinence, there may be other surgery techniques that may be a good option for you. Some examples include nerve-sparing surgery, robotic surgery, and laparoscopic surgery.

Radiation Therapy
Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors. Examples include:

  • Conformal radiation therapy—conformal radiation therapy uses three-dimensional radiation beams that are conformed into the shape of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.
  • Intensity-modulated radiation therapy (IMRT)— IMRT uses radiation beams of different intensities to deliver higher doses of radiation therapy to the tumor and lower doses to nearby tissues at the same time.
Hormone Therapy
If prostate cancer has spread or has returned after being treated, hormone therapy may be used. The goal of hormone therapy is to lower the levels of male hormones, called androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancer to shrink or slow its growth.

Hormone therapy may include:

  • Luteinizing hormone-releasing hormone (LHRH) analogs
  • Luteinizing hormone-releasing hormone (LHRH) antagonists
  • Anti-androgens
  • Estrogen therapy—rarely used now unless other treatments are not working
  • Antifungal medications
  • Antineoplastic agents
In some case, a type of surgery called orchiectomy may be needed. This involves removing the testicles, which stops androgens from being produced.

Other Treatment Options
Other options may include:

  • Cryosurgery—this involves using an instrument to freeze and destroy prostate cancer cells
  • Chemotherapy
  • Immunotherapy—a drug treatment that builds your immune system so that you can better fight cancer cells
  • Targeted therapies—focus on the cancer cells, rather than attacking both the cancer cells and the healthy cells
  • High-intensity focused ultrasound—an endorectal probe (a probe that is inserted into the rectum) is used to destroy cancer cells with ultrasound energy
Prevention
To help reduce your chance of prostate cancer, take the following steps:

  • Eat a healthful diet. Your diet should be high in fruits, vegetables, and fish, and low in red meat.
  • Ask your doctor about taking certain medications. For example, daily aspirin therapy and 5-alpha reductase inhibitors may reduce your risk of prostate cancer.



RESOURCES:
National Cancer Institute

Urology Care Foundation

CANADIAN RESOURCES:

Prostate Cancer Canada

References:
Angiogenesis inhibitors. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/angiogenesis-inhibitors. Updated October 7, 2011. Accessed September 25, 2014.

Biological therapies for cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/biological. Updated June 12, 2013. Accessed September 25, 2014.

Chemotherapy and targeted therapy. Texas Oncology website. Available at: http://www.texasoncology.com/types-of-cancer/prostate-cancer/targeted-therapy-for-prostate-cancer. Accessed September 25, 2014.

Enzalutamide. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 25, 2014. Accessed September 25, 2014.

Evolution of cancer treatments: targeted therapy. American Cancer Society website. Available at: http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-cancer-treatment-targeted-therapy. Updated June 12, 2014. Accessed September 25, 2014.

FDA approval for sipuleucel-T. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/druginfo/fda-sipuleucel-T. Updated July 3, 2013. Accessed September 25, 2014.

Imatinib. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 1, 2014. Accessed September 25, 2014.

Prostate cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003134-pdf.pdf. Accessed September 25, 2014.

Prostate cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 10, 2014. Accessed September 25, 2014.

Prostate cancer screening. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 4, 2014. Accessed September 25, 2014.

Prostate cancer staging and imaging. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 1, 2014. Accessed September 25, 2014.

What is biological therapy? National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/treatment/biologicaltherapy. Accessed September 25, 2014.

What is provenge immunotherapy? Provenge website. Available at: http://www.provenge.com/advanced-prostate-cancer-immunotherapy.aspx. Accessed July 31, 2012.

2/12/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Smith DP, King MT, Egger S, et al. Quality of life three years after diagnosis of localised prostate cancer: population based cohort study. BMJ. 2009;339:b4817.

2/19/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mahmud SM, Franco EL, Aprikian AG. Use of non-steroidal anti-inflammatory drugs (NSAIDs) and prostate cancer risk: A meta-analysis. Int J Cancer. 2010 Jan 20.

Last Reviewed August 2014



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