Prostate Cancer

Prostate cancer affects the tissues of the prostate gland. It occurs when the cells of the prostate grow uncontrollably. This is the most common malignancy found in men.

Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. There are some types of prostate cancer grow slowly and may need minimal or no treatment, while there are types which are aggressive and can spread quickly.

If prostate cancer is detected early — when it's still confined to the prostate gland then there is a 90% chance of successful treatment.

Risk factors

* Age. After age 40, the chance of having prostate cancer increases.

* Race or ethnicity. For reasons that aren't well understood, black men have a higher risk of developing prostate cancer.

* Family history. Men with a single first-degree relative—father, brother or son—with a history of prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. The risk is even higher if the affected family members were diagnosed at a young age, with the highest risk seen in men whose family members were diagnosed before age 60.

* Diet. A high-fat diet and obesity may increase the risk of prostate cancer. One theory is that fat increases production of the hormone testosterone, which may promote the development of prostate cancer cells.

* High testosterone levels. Because testosterone naturally stimulates the growth of the prostate gland, men who use testosterone therapy are more likely to develop prostate cancer than are men who have lower levels of testosterone.

Symptoms

Prostate cancer usually doesn't produce any noticeable symptoms in its early stages, so many cases of prostate cancer aren't detected until the cancer has spread beyond the prostate. For most men, prostate cancer is first detected during a routine screening such as a prostate-specific antigen (PSA) test or a digital rectal exam (DRE).

When signs and symptoms do occur, they depend on how advanced the cancer is and how far the cancer has spread.

Less than 5 percent of cases of prostate cancer have urinary problems as the initial symptom. When urinary signs and symptoms do occur, they can include:

* Trouble urinating
* Starting and stopping while urinating
* Decreased force in the stream of urine

Cancer in your prostate or the area around the prostate can cause:

* Blood in your urine
* Blood in your semen

Prostate cancer that has spread to the lymph nodes in your pelvis may cause:

* Swelling in your legs
* Discomfort in the pelvic area

Advanced prostate cancer that has spread to your bones can cause:

* Bone pain that doesn't go away
* Bone fractures
* Compression of the spine



Screening and Diagnosis

The first indication of a problem may come during a routine screening test, such as:

* Digital rectal exam (DRE).
During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate. The texture, shape and size of the gland is evaluated, if abnormalities are noted, there may be a need for more tests.



* Prostate-specific antigen (PSA) test.
PSA, is a substance that's naturally produced by the prostate gland to help liquefy semen. It's normal for a small amount of PSA to enter your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer. Screening with PSA and DRE can help identify cancer at an earlier stage.

* Transrectal ultrasound guided prostate biopsy.
If other tests raise concerns, a transrectal ultrasound guided prostate biopsy is perfomed to obtain a definitive diagnosis of the prostate pathology.

Who should be screened?

Both the PSA and DRE should be offered annually, beginning at age 40, to men who have at least a 10-year life expectancy. Men at high risk, such as African American men and men with a strong family history of one or more first-degree relatives diagnosed at an early age. However, all men aged 40 and above should speak with their doctors at the the time of their annual physical examinations and develop a prostate health plan.

Treatment options:

Treatment options for prostate cancer vary depending on the grade and stage of the cancer.

For low grade and early stage cancers(localized), surgery is the gold standard of treatment. Radical retropubic prostatectomy offers the highest cure rate for organ confined prostate cancers.

Other options include brachytherapy, radiation therapy, high intensity focused ultrasound (HIFU) and watchful waiting.

For moderately advanced and advanced prostate cancers, hormonal therapy plays an important role. If urinary symptoms are present, a transurethral resection of the prostate combined with the hormonal therapy is recommended.