Prostate cancer is cancer that grows in prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

Causes

• Unknown

• Prostate Cancers are classified (staged) by how aggressive they are and by the degree that they differ from the surrounding prostate tissue.

• The staging most generally used classifies the cancer into:

1. A -- the doctor is not able to feel the tumor on exam, but a biopsy (piece taken) will show the cancer cells under a microscope.

2. B -- the tumor is felt on the exam, but is still limited to the prostate.

3. C -- the tumor has extended outside the prostate, and may have invaded some of the nearby tissues (e.g., seminal vesicles and lymph nodes), but has not spread to distant body parts.

4. D -- the tumor cells have used the blood stream and lymphatic system (a system carrying a fluid containing white blood cells) to spread to distant body parts and organs (e.g., bones, lungs, liver, kidney, etc).

Risk Factors

• Age -- rarely occurs under 40, but very high rate in those over 75

• Eating animal products (fats) -- Japanese (high fish diet) and vegetarians have a lower incidence (chance of having) of PC

• Diet low in Zinc and vitamins such as E may play a role.

• Family history of PC and, in some cases, Ovarian Cancer (in mothers and sisters)

• African American males have highest rate of PC.

• Highest rate occurs in northern Europe and America.

• Lowest rates seen in Israel, Russia, and Japan.

• Moving from lowest risk areas to highest risk areas.

• Sexually transmitted diseases may play a role in PC.

• Hormones (i.e., testosterone) -- men who have been castrated (testicles removed) do not develop PC.

• Alcohol

• Smokers do worse when diagnosed with PC.

• Cadmium, Acryl Nitrite, and Dimethylformamide (DMF) exposure

• Farmers

• Vasectomy

• Non-melanoma skin cancer

• Slow growing tumor -- may take years for symptoms to develop

• Frequent urination

• Weak urinary stream

• Interruption of urinary stream (starting-stopping)

• Pain on urination

• Burning on urination

• Urinary dribbling -- urine drips after urination

• Difficulty in starting urination

• Pinkish urine or blood in urine

• Inability to urinate

• Pain during ejaculation

• Pain on moving the bowels

• Weight loss

• Loss of appetite

• Weakness and fatigue

• Shortness of breath

• Bone pain -- lower back pain, thighs, etc.

• Fractures may occur

• Urine infections may occur

• Blood clots may form in the legs

Screening and Diagnostics

     A rectal exam often reveals an enlarged prostate with a hard, irregular surface. A number of tests may be done to confirm the diagnosis of prostate cancer.

• PSA test may be high, although non-cancerous enlargement of the prostate can also increase PSA levels.

• Free PSA may help tell the difference between BPH and prostate cancer.

• Urinalysis may show blood in the urine.

• Urine or prostatic fluid cytology may reveal unusual cells.

• Prostate biopsy confirms the diagnosis.

• CT scans may be done to see if the cancer has spread.

• A bone scan may be done to see if the cancer has spread.

• Chest x-ray may be done to see if the cancer has spread.

     A newer test called AMACR is more sensitive for determining the presence of prostate cancer than the PSA test.

Treatment

• The doctor may consult with an urologist (male urine, prostate, penis doctor), surgeon, and oncologist (cancer specialist).

• Treatment depends on the stage of cancer.

• If biopsy shows a pre-cancerous (not yet cancer) condition known as intraepithelial neoplasia, treatment is necessary, and close observation and follow up will be needed (every 3-6 months for 2 years).

• When diagnosed in early stages (A-C), the cure rate is almost 98%.

• Because of the slow rate of growth, early stages can often be watched and followed clinically.

• Aggressive therapies (surgery and radiation) are often recommended for younger men (50 and younger) who have a life expectancy of 10 years or longer.

• Surgery and radiation both have many side effects including Impotence (inability to have an erection) and incontinence (inability to control or hold urine).

• Stages of A (A1 and A2) or age > 70 are often followed without treatment.

• For other stages without metastasis and low grades of stage C (C1) -- prostatectomy (surgical removal) of prostate and/or radiation (using radioactive substances or X-Rays) therapy are the options.

• For stages of C (more advance C2) and D -- chemotherapy (cancer killing drugs), hormone therapy using medications (Eulexin, Leupron, Zoladex), or removing the testicles (orchiectomy) may be combined with radiation.

• Pain management -- medications and therapies such as massage and physical therapy can help with pain.

• Eat a diet high in vitamins, zinc, vitamin E, fish, fruit, and vegetables.

• Ketoconazole and other drugs, immunotherapy (drugs that enhance the body's natural defenses), and the use of herbs such as PC-SPES are all being researched as forms of therapy.

• American Cancer Association recommends all men to have a PSA and rectal exam every year starting age 50.

• African Americans and those with risk factors may start as early as age 40.

Prognosis

     The outcome varies greatly, primarily because the disease is found in older men who may have a variety of other complicating diseases or conditions, such as cardiac or respiratory disease, or disabilities that immobilize or greatly decrease activities.

     Impotence is a potential complication after prostatectomy or radiation therapy. Recent improvements in surgical procedures have made this complication occur less often. Urinary incontinence is another possible complication. Medications can have side effects, including hot flashes and loss of sexual desire.

     There is no known prevention. Following a vegetarian, low-fat diet or one similar to the traditional Japanese diet may lower risk. Early identification (as opposed to prevention) is now possible by yearly screening of men over 40 or 50 years old through digital rectal examination (DRE) and PSA blood test.