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Arsenal

Prostat cancer


Preface

Praise and gratitude to the almighty God, for His blessings and leadership so that the manufacture of this paper can be resolved properly. The creation of this task for the accomplishment of tasks at once to be a source of information. We hope  this paper can be a source of reference for the readers .  we also believe that “No ivory that don’t rift “.   because this paper  has wrongness. hopefully the lack of it can be used as reference to achieve perfection.

We’ve thanks to our beloved parents that always give support (materials, morale,etc ) and also  our  teacher mr. Hendri Nelwan S.S that give this  task to us, so we can know more about prostat cancer

“Table of Contans”

Preface

Table of contans

1.   Capter 1 : foreword

1.1         backround

1.2         Problems Formula

1.3         Mean and Prupose

1.4         Writing method

1.5         Hypothesis

2.   Capter 2 : Disscusion

2.1         Definition

2.2

 

 

 

 

 

Chapter I

Foreword

1.1       Background

The prostate sits above the base of the penis below the urinary bladder and backs onto the front wall of the rectum. The main function of the prostate is to secrete fluid that nourishes and protects sperm. Figure 1 shows the anatomy of the prostate. Prostate cancer cancercous expanding [in] prostate, a gland in system reproduce the boy. This matter happened when prostate cell experience of the mutation and start to expand outside conducting. This cell can disseminate by metastasis from prostate to other body shares, especially bone and lymph node. cancer of Prostate dapa generate to feel the pain, difficulty urinate the, erectile disfungsi and other symptom

Sum up the prostate cancer highly varied world. But seldom be happened in Asia of East and South arch often happened [in] Europe and American Serikat. According To American of Cancer Society, rarest prostate cancer Asian man and most  often happened [in] black people, and European  tengahnya.in middle

patient found ratio of very vitamin B12 plasma very low.

1.2 PROBLEMS FORMULA

  • What’s the mean of prostat cancer
  • Generated symptom from human
  • Generated effect from prostat cancer
  • Way of curing prostat cancer

 

1.3 Mean and prupose

To know pathological prostate suffered by man that happened at sex of man and cause the happening of kaker prostate.

 

1.4. Writing Method

Descriptive: search inforrmation from Internet, literature studied and also mix our knowledge and experience about Prostat cancer

1.5 Hypotesis

  • Prostate cancer is cancercous expanding in prostate, a gland in system reproduce the boy. This matter is happened by when prostate cell experience of the mutation and start to expand outside conducting.

Capter II :

2. “Discussion”

Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease.

Rates of detection of prostate cancers vary widely across the world, with South and East Asia detecting less frequently than in Europe, and especially the United States. Prostate cancer tends to develop in men over the age of fifty and although it is one of the most prevalent types of cancer in men, many never have symptoms, undergo no therapy, and eventually die of other causes. This is because cancer of the prostate is, in most cases, slow-growing, symptom-free, and since men with the condition are older they often die of causes unrelated to the prostate cancer, such as heart/circulatory disease, pneumonia, other unconnected cancers, or old age. On the other hand, the more aggressive prostate cancers account for more cancer-related mortality than any other cancer except lung cancer. About two-thirds of cases are slow growing, the other third more aggressive and fast developing.

Many factors, including genetics and diet, have been implicated in the development of prostate cancer. The presence of prostate cancer may be indicated by symptoms, physical examination, prostate-specific antigen (PSA), or biopsy. The PSA test increases cancer detection but does not decrease mortality. Moreover, prostate test screening is controversial at the moment and may lead to unnecessary, even harmful, consequences in some patients. Nonetheless, suspected prostate cancer is typically confirmed by taking a biopsy of the prostate and examining it under a microscope. Further tests, such as CT scans and bone scans, may be performed to determine whether prostate cancer has spread.

Management strategies for prostate cancer should be guided the severity of the disease. Many low-risk tumors can be safely followed with active surveillance. Curative treatment generally involves surgery, various forms of radiation therapy, or, less commonly, cryosurgery, hormonal therapy and chemotherapy are generally reserved for cases of advanced disease (though hormonal therapy may be given with radiation in some cases).

The age and underlying health of the man, the extent of metastasis, appearance under the microscope, and response of the cancer to initial treatment are important in determining the outcome of the disease. The decision whether or not to treat localized prostate cancer (a tumor that is contained within the prostate) with curative intent is a patient trade-off between the expected beneficial and harmful effects in terms of patient survival and quality of life.

prostate gland is located between the bladder and in front of the rectum. The upper part of the urethra passes through the prostate gland, which can cause some serious problems if it becomes enlarged. They believe that the cancer is caused by changes in DNA. The reason for this is because some parts of the DNA give instructions to the cell about growth and division. This is where cancer comes into play, which is the division of cells gone mad. The genes that promote cell growth and division are oncogenes.

When this happens, it creates a tumor. The tumor will either be benign or malignant. Benign tumors do not spread like the malignant ones. When a malignant tumor spreads, it is called metastasis. Prostate cancer is when a malignant tumor is found in the prostate gland. The severity determines what stage the cancer is in, it will be in T1, T2, T3, or T4. “T1 and T2 are limited only to the prostate gland.”(source 1) T3 is when the cancer has already made its way into the tissue. T4 is when the cancer is spread all across the body. There are three types of prostate diseases: benign prostatic hyperplasia, prostatitis, and prostate cancer.
Benign prostatic hyperplasia is a not cancerous and is just and enlargement of the gland. It affects half of all men younger than 50 and 80% of men older than 60. These are some of the symptoms: difficulty urinating, an urge to urinate even when the bladder is empty, frequent urination, a weak or intermittent stream of urine, and a sense of incomplete emptying when urinating. Prostatitis is when the gland is inflamed because of a bacterial infection. This disease affects men of all ages that have a sized prostate. Some of the symptoms for prostatitis are the same with benign prostatic hyperplasia. The symptoms for prostatitis are: pain or burning during urination, chills and fever accompanied with urinating problems, difficulty urinating, and an urge to urinate even when the bladder is empty.

Prostate cancer in some of its early stages may not have any symptoms but as time goes on some things may begin to show. Prostate cancer shares treatments with both of the other diseases. Some of the symptoms of the cancer are: a need to urinate frequently, especially at night, difficulty starting urination, inability to urinate, weak or interrupted flow of urine, painful or burning urination, painful ejaculation, blood in urine or semen, and frequent pain or stiffness in the back, hips, or upper thighs.
Two test are commonly used to determine if a male has prostate cancer, which are digital rectum and a blood test. Digital Rectum is when the doctor feels the prostate through the rectum to find hard places and lumps, which are called nodules. When the blood test is performed the doctor looks for a substance called prostate-specific antigen. The test are both used to detect abnormalities in the prostate gland. The abnormalities help the doctor see whether the patient has prostate cancer. Although, men should be aware that these test, they do not detect all types of prostate cancer. Sometimes the cancer can be spotted by the symptoms the patient is having.
Radiation is a treatment option that is less dramatic and helps in the beginning stages. It can be done through beams that direct the dose to the prostate outside the body. With radiation, side effects maybe: depression, erectile dysfunction, swelling, urinary incontinence, bladder inflammation, bone marrow suppression, inflamed small intestine, and low blood count.
Cryotherapy is when prostate tumors are killed by freezing. Cryotherapy is painful and expensive, but helps preserve sexual function. A side effect is urinary discomfort that will soon go away. One treatment is called watchful waiting in which nothing is done, but they are watched. They also may decide that surgery can be done to fix the problem. Chemotherapy may be used as a treatment option too. Some side effects of chemotherapy include bleeding, high risk infections, and lowered blood counts. Radioactive seed implant may be done to kill the cancer, also. A side effect is difficulty with urination, which can usually be managed with medicine and improves with time. During the procedure, radioactive seeds are implanted into the prostate gland using ultrasound guidance. The implants remain active for about 10 months inside the prostate gland.
Although, scientist still do not know where the cancer originates from and how it gets started, they do know that the cancer forms in African American men more than other races. Men who have a family history of prostate cancer are, also, at a high risk for the disease. Testosterone contributes to the growth of the tumor. Testosterone is the male sex hormone.
Prostate Cancer is the second leading cause of death in today’s men. One in every six men who live to be 80 years old will experience the cancer. Prostate cancer is treatable in most cases, especially if caught in the early stages of development. Eighty-nine percent of men that have the cancer will live five years and 63% will live for 10 years or longer.

 

 

Early Detection of Prostate Cancer.
Men older than 50 years are encouraged to perform a total PSA (Prostate Specific Antigen) and digital rectal examination or DRE (Digital Rectal Examination) each year. If your family is suffering from prostate cancer, screening is recommended from the age of 40 years.

PSA
PSA is an enzyme released by the prostate gland and ejaculatory functions dilute fluid to facilitate the movement of sperm. In normal circumstances, only a little PSA enters the bloodstream. However, if there is inflammation or damage to the prostate tissue levels of PSA in the blood increases.
Then, how to distinguish an increase in PSA due to BPH or prostate cancer? To distinguish whether the elevated levels of PSA due to BPH or prostate cancer, the recommended ratio of free-PSA examination, total PSA or the ratio of c-PSA-total PSA, especially for those with total PSA levels between 2.6 to 10 ng / ml.

Familiar with the U.S. method (Active Surveillance)

To avoid over-diagnosis and over-treatment of prostate cancer, it has conducted research that called START (Surveillance Therapy Against Radical Treatment), led by Dr. Laurence Klotz (Chief Urologist of Sunnybrook Health Sciences Center, Toronto, Canada).

The results of international research found that when the U.S. method is applied to prostate cancer patients benign (slow growing prostate cancer), then the cancer has not spread and the overall mortality rate of less than 2%. This study is important because most men with prostate cancer is very hard to perform surgical removal of the prostate. Most of them stressed thinking about the impact of erectile dysfunction and incontinence (unable to hold urine) in the long run.

U.S. method (active surveillance) is a condition in which men with signs of pre-cancerous prostate and actively monitor the development of cancer. These patients do not need to undergo any medical treatment, such as surgery or radiotherapy for the parameters under control. However, if an increase in PSA, and then performed a medical act.

Patient characteristics that could make the U.S. methods are as follows.

A. PSA values less than or equal to 10.
2. Biopsy showed low-volume cancer with Gleason scores of 6 or less
* Gleason score is the cancer agency of 2 to 10 that indicates the aggressiveness of the cancer. The higher the number, the more aggressive the cancer.
3. The patient was sentenced to grade prostate cancer between T1c and T2a.
* T1 and T2 is the lowest stage of cancer, when cancer cells are still confined in the prostate gland.

Patients who follow the U.S. This new method gets medical treatment such as surgery or radiotherapy when the PSA value increased dramatically, increasing the volume of the biopsy shows cancer, or even the presence of cancer cells are more malignant.

Statistical test results showed that prostate cancer patients who perform the method the U.S., approximately 65% of it will remain on the condition that no mengganas cancer.

 

Table Stage Prostate Cancer
Stadium Information
I very early and without symptoms, the cancer cells confined to the prostate
II confined to the prostate cancer cells, but clearly visible (detected by digital rectal examination and / or a high PSA test results)
III The cancer cells are found outside the prostate sac (the membrane covering the prostate); limited spread to the surrounding tissues and / or seminal vesicles (glands that produce seminal fluid)
IV The cancer cells have spread (metastasized) to the regional lymph nodes, bone, or distant organs (eg, liver, lung)

All types of surgery for prostate cancer risk and side effects.
Surgery alone is the risk that may include: issues surrounding the anesthetic, a small risk of heart attack, stroke, blood clots in the legs, infection, and bleeding. This risk depends on various factors ranging from your overall health, your age, and expertise of the doctor who treated you.
The main side effects of radical prostatectomy are: incontinence and impotence.
Incontinence: Incontinence means you can not control the course of your urine (urine leakage). There are three types of incontinence, namely:
– Stress Incontinence: This type is most common after prostate surgery. Here, men experience urine leakage when they cough, laugh, sneeze, or exercise.
– Overflow incontinence: the man who had inkontensia overflow, they take a long time to urinate and urine flow is usually weak
– Urge incontinence: a man with this complaint usually has a sudden need to go to the bathroom and urinate.
In rare instances, men lose all ability to control their urine. This is called continuous incontinence.

Usually the problem of incontinence will go away and someone starts to control natural urine normally take weeks or months after surgery. Doctors can not predict how long this can happen because the physical recovery of each person is different. Recovery can be accelerated, for example with Kegel exercises to strengthen your bladder.
Impotence: Impotence means that a man can not get an erection that is strong enough to be able to have sex. Nerves that allow a person to get an erection may be damaged during surgery, radiotherapy, or other treatments. During the first 3 to 12 months after surgery, you may not be able to get an erection without using medication or other treatment. Then, some people will be able to get an erection and some still will have trouble. Your ability to return to an erection depends on the age and type of surgery performed. The younger the age you are, the more likely you will be able to get an erection. If you still get an erection, you can still feel the orgasm. However, you will feel ‘dry’, in the absence of seminal fluid that comes out.
If you are worried about this erection problem (after surgery), discuss with your doctor to find a way out. There are medications and perhaps even devices like vacuum pumps and penile implants may help.
Infertility: A radical prostatectomy involves cutting the tubes between the testicles and the urethra. This means that a man can no longer be a natural father. For elderly men, this is often not a problem. But if this is a problem for you, discuss this with your doctor before surgery.
Lymphedema: A rare side effect is lymphedema, the swelling (in the legs or genital area) and pain. Lymphedema can often be treated with physical therapy, but may not disappear entirely.
Changes in the size / length of the penis: Other side effects may decrease the length of the penis surgery. Doctors do not yet know what causes it.

 

Signs and symptoms

Early prostate cancer usually causes no symptoms. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hyperplasia. These include frequent urination, nocturia (increased urination at night), difficulty starting and maintaining a steady stream of urine, hematuria (blood in the urine), and dysuria (painful urination).

Growth of prostate cancer is often very slow, can not cause symptoms for years. With the enlargement of the cancer, the complaints started to arise because of the pressure on the urethra to cause irritation or clogging the flow of urine. The symptoms include:

* The urine is not smooth. Weak urine flow, and it may take longer to finish urinating.
* Delays. You may have to wait a while on the toilet until the urine starts to flow.
* Droplets. Little urine may drip and stain your underpants soon after you finish urinating in the toilet.
* Frequency. You urinate more often than usual.
* Urgency. You feel very ‘dying’ urine suddenly.
* Less complete. You feel you do not pee really finished.
Note: all of the above symptoms are felt much older men. Most of those who feel it is only exposed to non-cancerous prostate enlargement. Should see her doctor to make sure.
* Other symptoms such as pain at the base of the penis or bloody urine occur only in advanced prostate cancer.

Prostate cancer is associated with urinary dysfunction as the prostate gland surrounds the prostatic urethra. Changes within the gland, therefore, directly affect urinary function. Because the vas deferens deposits seminal fluid into the prostatic urethra, and secretions from the prostate gland itself are included in semen content, prostate cancer may also cause problems with sexual function and performance, such as difficulty achieving erection or painful ejaculation.

Advanced prostate cancer can spread to other parts of the body, possibly causing additional symptoms. The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis, or ribs. Spread of cancer into other bones such as the femur is usually to the proximal part of the bone. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence.

Early-stage prostate cancer, no symptoms. Once cancer develops, new onset of symptoms but not typical. Symptoms which appears to resemble the symptoms of BPH (benign prostatic hyperplasia), benign prostate enlargement disease is frequently encountered in elderly men. As a result, the disease is difficult to distinguish from that required examination can detect early as well as distinguish between prostate cancer and BPH.

Here are some symptoms that are often found in prostate cancer patients.
1. Frequent urge to urinate, especially at night.
2. Difficulty to start urinating or to hold urine.
3. Urine flow is weak or interrupted.
4. Feelings of pain or burning during urination.
5. Blood in urine or semen.
6. Other sexual disorders, such as hard erection or painful ejaculation.
7. Frequent pain or stiffness in lower back, hips, or upper thighs.

Identify the characteristics of prostate cancer

Prostate cancer is a type of cancer causes most deaths in men number three. For men aged over 74 years, is the major cancers that cause death. Prostate cancer is rare in men under 40 years old.

Prostate cancer usually causes no symptoms outstanding (extraordianary), because cancer cells grow slowly and spread very slowly. If not careful, people realized Ketka cancer has reached an advanced stage. Here are some signs of prostate cancer should be aware of:

* You can take several seconds to start urinating / remove urine
* The flow of urine is not smooth or discontinuous; urine / urine flows slowly and it took a long time to urinate. This is caused by partial blockage in the flow of urine through the urethra
* Feeling “still left”: although you’ve finished urinating, but you still have not had to go all out; urine still dripping though has finished urinating; few moments later, a little urine is “left behind” all of a sudden out so wet your pants
* The urine is red (with blood)
* You have trouble holding urine
* You often feel suddenly dying for a pee and frequency of your urination becomes more frequent
* You often wake up at night to urinate
* You feel pain when urinating or ejaculating or during defecation
* You feel pain in lower back
* You feel pain at the base of the penis (if the cancer is already advanced stage)

Some of the above symptoms are normal symptoms are common in older men because prostate enlargement normal (not cancerous). If you are in doubt you should see a doctor. If left untreated, prostate cancer can spread to the bones (particularly the pelvic bones, ribs and spine) or to the kidneys (causing kidney failure).

Most prostate cancers do not cause symptoms because of its spread is very slow. In some cases, newly diagnosed prostate cancer after spread to the bones (particularly the pelvic bones, ribs and spine) or to the kidneys (causing kidney failure). Painful bone cancer and brittle bones that easily fracture (broken bone).
Although the early symptoms are not apparent, in most patients with prostate cancer often found some of the signs. Among other things, usually water still dripping urine, pain when urinating, pain during ejaculation, lower back pain, pain during bowel movements, and weight loss.
Alternative prostate cancer treatment with herbal remedy is thus following Plus.Kenapa XAMthone the reason:
Composition of mangosteen (mangosteen whole section):
* Roselle Flowers
* Apples
* Wine
* Preservatives used pure honey that is free from chemicals
Where there are substances in mangosteen xanthones, which proved effective in crushing various kinds of cancer, heart disease, diabetes, uterine cysts, dll.Zat xanthones serves as an active anti-cancer agents, anti-diabetic, anti-virus, anti-bacterial, anti- -fungal, and anti-inflammatory.

As we know, a common problem caused prostate enlargement residual urine is not out in the following sempurna.Nah XAMthone Plus 4 ways to combat prostate cancer:

A. Antibiotic properties of the mangosteen will work to reduce and eventually eliminate the infection from traces of urine in the body.
2. Second, anti-inflammatory properties in xamthones working to shrink the enlarged gland.
3. Substances contained in the mangosteen xanthones provide total support to the body so that you can recover more quickly while reducing the risk of prostate cancer re-infection
4. Plus there is the composition of the product XAMthone apples, where apples and beans are also known to have properties to prevent prostate cancer because the content of the active compound quacertin. Recommendation was submitted to experts from the Mayo Clinic published in the journal Carcinogenesis.
In the laboratory tests, Nianzeng Xing, a cancer specialist at Mayo Clinic Department of Urology, proving that quacertin, could block the receptor of male hormones (androgens) that can prevent prostate cancer.

Various studies have revealed that apples are rich in fiber, phytochemicals, and flavonoids. Flavonoid substances, based on study of the National Cancer Institute of the United States, can reduce the risk of a disease and lung cancer by 50 percent.
The prostate is a gland located below the bladder in men. The main function of the prostate is to produce fluid which protects and deliver sperm.
The prostate often enlarges gradually after the age of 50 years. At the age of 70 years, 80% of men have an enlarged prostate. Many older men who have problems urinating due to prostate enlargement (non-cancerous). In some men, enlargement was followed by the growth of cancer.
Prostate Cancer
Prostate cancer occurs when prostate cells to grow faster than normal conditions to form lumps or tumors that have a malignancy. Is the most common cancer in men, especially those aged over 65 years.
As with other cancers, prostate cancer causes are unknown. Here are some factors that increase cancer risk are:
* Age. Most cases occur in older men.
* Family history and hereditary factors. If your father or your brother to get prostate cancer at relatively young ages (under 60), the higher your risk. Also if your sister with breast cancer.
* Ethnic groups. Asian men have a lower risk than black men or white.
* Exposure to cadmium metal

Causes

The specific causes of prostate cancer remain unknown. The primary risk factors are age and family history. Prostate cancer is very uncommon in men younger than 45, but becomes more common with advancing age. The average age at the time of diagnosis is 70. However, many men never know they have prostate cancer. Autopsy studies of Chinese, German, Israeli, Jamaican, Swedish, and Ugandan men who died of other causes have found prostate cancer in thirty percent of men in their 50s, and in eighty percent of men in their 70s. Men who have first-degree family members with prostate cancer appear to have double the risk of getting the disease compared to men without prostate cancer in the family. This risk appears to be greater for men with an affected brother than for men with an affected father. In the United States in 2005, there were an estimated 230,000 new cases of prostate cancer and 30,000 deaths due to prostate cancer. Men with high blood pressure are more likely to develop prostate cancer. There is a small increased risk of prostate cancer associated with lack of exercise. A 2010 study found that prostate basal cells were the most common site of origin for prostate cancers. As with other cancers, prostate cancer causes are unknown. Here are some factors that increase cancer risk are:

* Age. Most cases occur in older men.
* Family history and hereditary factors. If your father or your brother to get prostate cancer at relatively young ages (under 60), the higher your risk. Also if your sister with breast cancer.
* Ethnic groups. Asian men have a lower risk than black men or white.
* Exposure to cadmium metal

Genetic

Genetic background may contribute to prostate cancer risk, as suggested by associations with race, family, and specific gene variants. Men who have a first-degree relative (father or brother) with prostate cancer have twice the risk of developing prostate cancer, and those with two first-degree relatives affected have a fivefold greater risk compared with men with no family history.   In the United States, prostate cancer more commonly affects black men than white or Hispanic men, and is also more deadly in black men. In contrast, the incidence and mortality rates for Hispanic men are one third lower than for non-Hispanic whites. Studies of twins in Scandinavia suggest that forty percent of prostate cancer risk can be explained by inherited factors.

No single gene is responsible for prostate cancer; many different genes have been implicated. Mutations in BRCA1 and BRCA2, important risk factors for ovarian cancer and breast cancer in women, have also been implicated in prostate cancer. Other linked genes include the Hereditary Prostate cancer gene 1 (HPC1), the androgen receptor, and the vitamin D receptor. TMPRSS2ETS gene family fusion, specifically TMPRSS2-ERG or TMPRSS2-ETV1/4 promotes cancer cell growth.

Loss of cancer suppressor genes, early in the prostatic carcinogenesis, have been localized to chromosomes 8p, 10q, 13q,and 16q. P53 mutations in the primary prostate cancer are relatively low and are more frequently seen in metastatic settings, hence, p53 mutations are late event in pathology of prostate cancer. Other tumor suppressor genes that are thought to play a role in prostate cancer include PTEN (gene) and KAI1. “Up to 70 percent of men with prostate cancer have lost one copy of the PTEN gene at the time of diagnosis” Relative frequency of loss of E-cadherin and CD44 has also been observed.

Dietary

While a number of dietary factors have been linked to prostate cancer the evidence is still tentative. Evidence supports little role for dietary fruits and vegetables in prostate cancer occurrence. Red meat and processed meat also appear to have little effect. Lower blood levels of vitamin D may increase the risk of developing prostate cancer. This may be linked to lower exposure to ultraviolet (UV) light, since UV light exposure can increase vitamin D in the body.

Green tea may be protective (due to its catechins content), although the most comprehensive clinical study indicates that it has no protective effect. Other holistic methods are also studied.

Taking multivitamins more than seven times a week may increase the risks of contracting the disease. This research was unable to highlight the exact vitamins responsible for this increase (almost double), although they suggest that vitamin A, vitamin E and beta-carotene may lie at its heart. It is advised that those taking multivitamins never exceed the stated daily dose on the label.

Folic acid supplements have recently been linked to an increase in risk of developing prostate cancer. A ten-year research study led by University of Southern California researchers showed that men who took daily folic acid supplements of 1 mg were three times more likely to be diagnosed with prostate cancer than men who took a placebo.

High alcohol intake may increase the risk of prostate cancer and interfere with folate metabolism. Low folate intake and high alcohol intake may increase the risk of prostate cancer to a greater extent than the sole effect of either one by itself. A case control study consisting of 137 veterans addressed this hypothesis and the results were that high folate intake was related to a 79% lower risk of developing prostate cancer and there was no association between alcohol consumption by itself and prostate cancer risk. Folate’s effect however was only significant when coupled with low alcohol intake. There is a significant decrease in risk of prostate cancer with increasing dietary folate intake but this association only remains in individuals with low levels of alcohol consumption. There was no association found in this study between folic acid supplements and risk of prostate cancer.

Medication exposure

There are also some links between prostate cancer and medications, medical procedures, and medical conditions. Use of the cholesterol-lowering drugs known as the statins may also decrease prostate cancer risk.

Infection or inflammation of the prostate (prostatitis) may increase the chance for prostate cancer while another study shows infection may help prevent prostate cancer by increasing blood to the area. In particular, infection with the sexually transmitted infections chlamydia, gonorrhea, or syphilis seems to increase risk. Finally, obesityand elevated blood levels of testosterone may increase the risk for prostate cancer. There is an association between vasectomy and prostate cancer however more research is needed to determine if this is a causative relationship.

Research released in May 2007, found that US war veterans who had been exposed to Agent Orange had a 48% increased risk of prostate cancer recurrence following surgery.

Viral

In 2006, researchers associated a previously unknown retrovirus, Xenotropic MuLV-related virus or XMRV, with human prostate tumors. Subsequent reports on the virus have been contradictory. A group of US researchers found XMRV protein expression in human prostate tumors, while German scientists failed to find XMRV-specific antibodies or XMRV-specific nucleic acid sequences in prostate cancer samples.

Pathophysiology

The prostate is a part of the male reproductive system that helps make and store seminal fluid. In adult men, a typical prostate is about three centimeters long and weighs about twenty grams. It is located in the pelvis, under the urinary bladder and in front of the rectum. The prostate surrounds part of the urethra, the tube that carries urine from the bladder during urination and semen during ejaculation. Because of its location, prostate diseases often affect urination, ejaculation, and rarely defecation. The prostate contains many small glands which make about twenty percent of the fluid constituting semen. In prostate cancer, the cells of these prostate glands mutate into cancer cells. The prostate glands require male hormones, known as androgens, to work properly. Androgens include testosterone, which is made in the testes; dehydroepiandrosterone, made in the adrenal glands; and dihydrotestosterone, which is converted from testosterone within the prostate itself. Androgens are also responsible for secondary sex characteristics such as facial hair and increased muscle mass.

When normal cells are damaged beyond repair, they are eliminated by apoptosis. Cancer cells avoid apoptosis and continue to multiply in an unregulated manner.

Prostate cancer is classified as an adenocarcinoma, or glandular cancer, that begins when normal semen-secreting prostate gland cells mutate into cancer cells. The region of prostate gland where the adenocarcinoma is most common is the peripheral zone. Initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, a condition known as carcinoma in situ or prostatic intraepithelial neoplasia (PIN). Although there is no proof that PIN is a cancer precursor, it is closely associated with cancer. Over time, these cancer cells begin to multiply and spread to the surrounding prostate tissue (the stroma) forming a tumor. Eventually, the tumor may grow large enough to invade nearby organs such as the seminal vesicles or the rectum, or the tumor cells may develop the ability to travel in the bloodstream and lymphatic system. Prostate cancer is considered a malignant tumor because it is a mass of cells that can invade other parts of the body. This invasion of other organs is called metastasis. Prostate cancer most commonly metastasizes to the bones, lymph nodes, and may invade rectum, bladder and lower ureters after local progression. The route of metastasis to bone is thought to be venous as the prostatic venous plexus draining the prostate connects with the vertebral veins.

The prostate is a zinc accumulating, citrate producing organ. The protein ZIP1 is responsible for the active transport of zinc into prostate cells. One of zinc’s important roles is to change the metabolism of the cell in order to produce citrate, an important component of semen. The process of zinc accumulation, alteration of metabolism, and citrate production is energy inefficient, and prostate cells sacrifice enormous amounts of energy (ATP) in order to accomplish this task. Prostate cancer cells are generally devoid of zinc. This allows prostate cancer cells to save energy not making citrate, and utilize the new abundance of energy to grow and spread. The absence of zinc is thought to occur via a silencing of the gene that produces the transporter protein ZIP1. ZIP1 is now called a tumor suppressor gene product for the gene SLC39A1. The cause of the epigenetic silencing is unknown. Strategies which transport zinc into transformed prostate cells effectively eliminate these cells in animals. Zinc inhibits NF-κB pathways, is anti-proliferative, and induces apoptosis in abnormal cells. Unfortunately, oral ingestion of zinc is ineffective since high concentrations of zinc into prostate cells is not possible without the active transporter, ZIP1.

RUNX2 is a transcription factor that prevents cancer cells from undergoing apoptosis thereby contributing to the development of prostate cancer.

The PI3k/Akt signaling cascade works with the transforming growth factor beta/SMAD signaling cascade to ensure prostate cancer cell survival and protection against apoptosis. X-linked inhibitor of apoptosis (XIAP) is hypothesized to promote prostate cancer cell survival and growth and is a target of research because if this inhibitor can be shut down then the apoptosis cascade can carry on its function in preventing cancer cell proliferation. Macrophage inhibitory cytokine-1 (MIC-1) stimulates the focal adhesion kinase (FAK) signaling pathway which leads to prostate cancer cell growth and survival.

The androgen receptor helps prostate cancer cells to survive and is a target for many anti cancer research studies; so far, inhibiting the androgen receptor has only proven to be effective in mouse studies. Prostate specific membrane antigen (PSMA) stimulates the development of prostate cancer by increasing folate levels for the cancer cells to use to survive and grow; PSMA increases available folates for use by hydrolyzing glutamated folates.

Diagnosis

The American Cancer Society’s position regarding early detection is “Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. The American Cancer Society believes that men should not be tested without learning about what we know and don’t know about the risks and possible benefits of testing and treatment. Starting at age 50, (45 if African American or brother or father suffered from condition before age 65) talk to your doctor about the pros and cons of testing so you can decide if testing is the right choice for you.

The only test that can fully confirm the diagnosis of prostate cancer is a biopsy, the removal of small pieces of the prostate for microscopic examination. However, prior to a biopsy, less invasive testing can be conducted.

According to Professor Hardev Pandha, The Prostate Project Chair of Urological Oncology at the University of Surrey’s Postgraduate Medical School, a non-invasive test looking for the presence of the protein Engrailed-2 (EN2) in the urine to be more reliable and accurate than existing tests.

“In this study, we showed that the new test was twice as good at finding prostate cancer as the standard PSA test. Only rarely did we find EN2 in the urine of men who were cancer free, so if we find EN2 we can be reasonably sure that a man has prostate cancer. EN2 was not detected in men with non-cancer disorders of the prostate such as prostatitis or benign enlargement. These conditions often cause a high PSA result, causing considerable stress for the patient and sometimes also unnecessary further tests such as prostate biopsies.

There are also several other tests that can be used to gather more information about the prostate and the urinary tract. Digital rectal examination (DRE) may allow a doctor to detect prostate abnormalities. Cystoscopy shows the urinary tract from inside the bladder, using a thin, flexible camera tube inserted down the urethra. Transrectal ultrasonography creates a picture of the prostate using sound waves from a probe in the rectum.

Prostate imaging

Ultrasound (US) and Magnetic Resonance Imaging (MRI)are the two main imaging methods used for prostate cancer detection. Urologists use transrectal ultrasound during prostate biopsy and can sometimes see a hypoechoic area. But US has poor tissue resolution and thus, is generally not clinically used. In contrast, prostate MRI has superior soft tissue resolution. MRI is a type of imaging that uses magnetic fields to locate and characterize prostate cancer. Multi-parametric prostate MRI consists of four types of MRI sequences called T2 weighted imaging, T1 weighted imaging, Diffusion Weighted Imaging, MR Spectrocopic Imaging and Dynamic-Contrast Enhanced Imaging. Genitourinary radiologists use multi-parametric MRI to locate and identify prostate cancer. Currently, MRI is used to identify targets for prostate biopsy using fusion MRI with ultrasound (US) or MRI-guidance alone. In men who are candidates for active surveillance, fusion MR/US guided prostate biopsy detected 33% of cancers compared to 7% with standard ultrasound guided biopsy. Prostate MRI is also used for surgical planning for men undergoing robotic prostatectomy. It has also shown to help surgeons decide whether to resect or spare the neurovascular bundle, determine return to urinary continence and help assess surgical difficulty. Some prostate advocacy groups believe prostate MRI should be used to screen for prostate cancer–“manogram”– like mammogram is for breast cancer. NIH-funded clinical trials are underway to delineate the value of MRI for some of these applications.

Biopsy

Micrograph showing a prostate cancer (conventional adenocarcinoma) with perineural invasion. H&E stain.

If cancer is suspected, a biopsy is offered expediently. During a biopsy a urologist or radiologist obtains tissue samples from the prostate via the rectum. A biopsy gun inserts and removes special hollow-core needles (usually three to six on each side of the prostate) in less than a second. Prostate biopsies are routinely done on an outpatient basis and rarely require hospitalization. Fifty-five percent of men report discomfort during prostate biopsy.

Gleason score

The tissue samples are then examined under a microscope to determine whether cancer cells are present, and to evaluate the microscopic features (or Gleason score) of any cancer found. Prostate specific membrane antigen is a transmembrane carboxypeptidase and exhibits folate hydrolase activity. This protein is overexpressed in prostate cancer tissues and is associated with a higher Gleason score.

Tumor markers

Tissue samples can be stained for the presence of PSA and other tumor markers in order to determine the origin of malignant cells that have metastasized.

Small cell carcinoma is a very rare (1%) type of prostate cancer that cannot be diagnosed using the PSA. As of 2009[update] researchers are trying to determine the best way to screen for this type of prostate cancer because it is a relatively unknown and rare type of prostate cancer but very serious and quick to spread to other parts of the body. Possible methods include chromatographic separation methods by mass spectrometry, or protein capturing by immunoassays or immunized antibodies. The test method will involve quantifying the amount of the biomarker PCI, with reference to the Gleason Score. Not only is this test quick, it is also sensitive. It can detect patients in the diagnostic grey zone, particularly those with a serum free to total Prostate Specific Antigen ratio of 10-20%.

The oncoprotein BCL-2, has been associated with the development of androgen-independent prostate cancer due to its high levels of expression in androgen-independent tumours in advanced stages of the pathology. The upregulation of BCL-2 after androgen ablation in prostate carcinoma cell lines and in a castrated-male rat model further established a connection between BCL-2 expression and prostate cancer progression.

The expression of Ki-67 by immunohistochemistry may be a significant predictor of patient outcome for men with prostate cancer.[69]

ERK5 is a protein that may be used as a marker. ERK5 is present in abnormally high levels of prostate cancer, including invasive cancer which has spread to other parts of the body. It is also present in relapsed cancer following previous hormone therapy. Research shows that reducing the amount of ERK5 found in cancerous cells reduces their invasiveness.

Classification

An important part of evaluating prostate cancer is determining the stage, or how far the cancer has spread. Knowing the stage helps define prognosis and is useful when selecting therapies. The most common system is the four-stage TNM system (abbreviated from Tumor/Nodes/Metastases). Its components include the size of the tumor, the number of involved lymph nodes, and the presence of any other metastases.[71]

The most important distinction made by any staging system is whether or not the cancer is still confined to the prostate. In the TNM system, clinical T1 and T2 cancers are found only in the prostate, while T3 and T4 cancers have spread elsewhere. Several tests can be used to look for evidence of spread. These include computed tomography to evaluate spread within the pelvis, bone scans to look for spread to the bones, and endorectal coil magnetic resonance imaging to closely evaluate the prostatic capsule and the seminal vesicles. Bone scans should reveal osteoblastic appearance due to increased bone density in the areas of bone metastasis—opposite to what is found in many other cancers that metastasize.

After a prostate biopsy, a pathologist looks at the samples under a microscope. If cancer is present, the pathologist reports the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue and suggests how fast the tumor is likely to grow. The Gleason system is used to grade prostate tumors from 2 to 10, where a Gleason score of 10 indicates the most abnormalities. The pathologist assigns a number from 1 to 5 for the most common pattern observed under the microscope, then does the same for the second-most-common pattern. The sum of these two numbers is the Gleason score. The Whitmore-Jewett stage is another method sometimes used.

 Screening

Prostate cancer screening is an attempt to find unsuspected cancers, and may lead to more specific follow-up tests such as a biopsy, with cell samples taken for closer study. Options include the digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test. Such screening is controversial and, in some patients, may lead to unnecessary, even harmful, consequences. A 2010 analysis concluded that routine screening with either a DRE or PSA is not supported by the evidence as there is no mortality benefit from screening. More recently, the United States Preventive Services Task Force (USPSTF) recommended against the PSA test for prostate cancer screening in healthy men. This USPSTF recommendation, released in October 2011, is based on “review of evidence” studies concluding that “Prostate-specific antigen–based screening results in small or no reduction in prostate cancer–specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.

Modern screening tests have found cancers that might never have developed into serious disease, and that “the slight reduction of risk by surgically removing the prostate or treating it with radiation may not outweigh the substantial side effects of these treatments,” an opinion also shared by the CDC.

Prevention

There is a significant relation between lifestyle (including food consumption) and cancer prevention.

Medications

Two medications which block the conversion of testosterone to dihydrotestosterone, finasteride and dutasteride, have also shown some promise. The use of these medications for primary prevention is still in the testing phase, and they are not widely used for this purpose. A 2008 study found that finasteride reduces the incidence of prostate cancer by 30%, without any increase in the risk of High-Grade prostate cancer. In the original study it turns out that the smaller prostate caused by finasteride means that a doctor is more likely to hit upon cancer nests and more likely to find aggressive-looking cells.

Compared to placebo treatment, taking 5-alpha-reductase inhibitors (5-ARIs) can reduce a man’s risk of being diagnosed with prostate cancer from around 5–9% to around 4-6% during up to 7 years of treatment, according to a Cochrane Review of studies.

Ejaculation frequency

More frequent ejaculation also may decrease a man’s risk of prostate cancer. One study showed that men who ejaculated 3-5 times a week at the age of 15-19 had a decreased rate of prostate cancer when they are old, though other studies have shown no benefit. The results contradict those of previous studies, that suggested that having many sexual partners, or a high frequency of sexual activity, increases the risk of prostate cancer by up to 40 percent. A key difference may be that these earlier studies defined sexual activity as sexual intercourse, whereas this study focused on the number of ejaculations, whether or not intercourse was involved. Another study completed in 2004 reported that “Most categories of ejaculation frequency were unrelated to risk of prostate cancer. However, high ejaculation frequency was related to decreased risk of total prostate cancer.” The report abstract concluded, “Our results suggest that ejaculation frequency is not related to increased risk of prostate cancer.

Diet

Consuming fish appears to lower prostate cancer deaths but not the occurrence of prostate cancer. Omega-3 fatty acids are unlikely to prevent prostate cancer. There is no evidence that vitamin supplements affect risk. Trans fats may be associated with an increased risk of cancer but the evidence is still limited. The American Dietetic Association and Dieticians of Canada report a decreased incidence of prostate cancer for those following a vegetarian diet.

Management

Making decisions

The first decision to be made in managing prostate cancer is whether any treatment at all is needed. Prostate cancer, especially the most common, low-grade forms found in the typical elderly patient, often grows so slowly that no treatment is required at all. Donald Gleason, the inventor of the Gleason score, advocated for renaming the very common 3+3 prostate “cancer” to prostate adenosis, because he believed it so unlikely to harm the patient. Treatment may also be inappropriate or impossible if the patient has other serious health problems or is not expected to live long enough for symptoms to appear.

Which option is best depends on the stage of the disease, the Gleason score, and the PSA level. Other important factors are age, general health, and patient views about potential treatments and their possible side effects. Because all treatments can have significant side effects, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations. A combination of the treatment options is often recommended for managing prostate cancer.

The National Comprehensive Cancer Network (NCCN) offers evidence-based guidelines for prostate cancer that can guide treatment choices for specific clinical situations. This requires a good estimation of the patient’s long-term health-adjusted life expectancy, because this factor is the most important determinant of survival in newly diagnosed patients. A simplified approach shows how to estimate health-adjusted life expectancy and apply the NCCN guidelines so that patients can have a roadmap to reach the decision recommended for their clinical situation, which they can alter according to their personal values, including fear of cancer and fear of side effects.

Patients can also use a newly developed 18-item questionnaire to learn whether they have good knowledge and understanding about their treatment options before they choose an option. Most newly diagnosed patients who have already made a treatment choice can not correctly answer over half of the questions.

The selection of treatment options involves many factors. For example, if radiation therapy is done first, and fails, then radical prostatectomy is a very technically challenging surgery and may not be feasible. On the other hand, radiation therapy done after surgical failure may have many complications. The desire to maximize subsequent options in case of failure may affect the treatment decision.

Active surveillance

Many men diagnosed with low-risk prostate cancer are eligible for active surveillance. This term implies careful observation of the tumor over time, with the intention of treatment for cure if there are signs of cancer progression. Active surveillance is not synonymous with watchful waiting, an older term which implies no treatment or specific program of monitoring, with the assumption that palliative, not curative, treatment would be used if advanced, symptomatic disease develops.

Active surveillance involves monitoring the tumor for signs of growth or the appearance of symptoms. The monitoring process may involve serial PSA, physical examination of the prostate, and/or repeated biopsies. The goal of surveillance is to avoid overtreatment and the sometimes serious, permanent side effects of treatment for a slow-growing or self-limited tumor that would never cause any problems for the patient. This approach is not used for aggressive cancers, but it may cause anxiety for patients who wrongly believe that all cancer is deadly or themselves to have a life-threatening cancer.

For the 50% to 75% of patients with prostate cancer that will cause no harm before the man dies of something unrelated, active surveillance may be the best choice.

Aggressive treatment

Treatment for aggressive prostate cancers involves surgery (i.e. radical prostatectomy), radiation therapy including brachytherapy (prostate brachytherapy) and external beam radiation therapy, High-intensity focused ultrasound (HIFU), chemotherapy, oral chemotherapeutic drugs (Temozolomide/TMZ), cryosurgery, hormonal therapy, or some combination.

Because of PSA screening, almost 90% of patients are diagnosed when the cancer is localized to the prostate gland and its removal by surgery or radiotherapy will in most cases lead to a cure. Because of this almost 94% of U.S. patients choose treatment. However, in 50% to 75% of these patients the cancer would not have affected their survival even without treatment, and by accepting treatment they have a high chance of sexual, urinary, and bowel side effects. For instance, two-thirds of treated patients cannot get sufficient erections for intercourse, and almost a third have urinary leakage. However, some cancers will grow faster and prostate cancer is the second most common reason of cancer death in U.S. men, after lung cancer.

Although the widespread use of prostate specific antigen (PSA) screening in the USA has resulted in diagnosis at earlier age and cancer stage, the vast majority of cases are still diagnosed in men older than 65 years, and approximately 25% of cases are diagnosed in men older than 75 years. Though US National Comprehensive Cancer Network guidelines recommend using life expectancy greater than or less than 10 years to help make treatment decisions, in practice, many elderly patients are not offered curative treatment options such as radical prostatectomy (RP) or radiation therapy and are instead treated with hormonal therapy or watchful waiting. This pattern can be attributed to factors such as medical co-morbidity and patient preferences is regard to quality of life in addition to prostate cancer specific risk factors such as pretreatment PSA, Gleason score and clinical stage. As the average life expectancy increases due to advances in treatment of cardiovascular, pulmonary and other chronic disease, it is likely that more elderly patients will be living long enough to suffer the consequences of their prostate cancer. Therefore, there is currently much interest in the role of aggressive prostate cancer treatment modalities such as with surgery or radiation in the elderly population who have localized disease. The results of one randomized controlled trial published by the Scandinavian Prostate Cancer Group 4  evaluated cancer-specific mortality in patients treated with RP compared with watchful waiting. The patients receiving radical prostatectomy had a relative risk reduction of 30.7% [95% confidence interval 2.5%-50.7%], but an absolute risk reduction of 6% [95% confidence interval 0.5%-11.5%]. The number needed to treat was calculated to be 16. This means that, over the median follow up period of approximately 10 years, 16 patients with localized prostate cancer would need to receive radical prostatectomy rather than watchful waiting in order to prevent one death due to prostate cancer. Further subset analysis revealed that this benefit did not apply to all ages equally. In men younger than 65 years, patients randomized to receive radical prostatectomy actually had a 10-18% absolute risk reduction in cancer-specific mortality compared to those randomized to watchful waiting. However, in men older than 65, there was no statistically significant risk reduction even when adjusted for PSA level, Gleason score and tumor stage. Randomized, controlled trials comparing radical prostatectomy, radiation therapy, hormonal therapy and watchful waiting would provide the best evidence for how to best treat elderly patients.

If the cancer has spread beyond the prostate, treatment options significantly change, so most doctors that treat prostate cancer use a variety of nomograms to predict the probability of spread. Treatment by watchful waiting/active surveillance, external beam radiation therapy, brachytherapy, cryosurgery, HIFU, and surgery are, in general, offered to men whose cancer remains within the prostate. Hormonal therapy and chemotherapy are often reserved for disease that has spread beyond the prostate. However, there are exceptions: radiation therapy may be used for some advanced tumors, and hormonal therapy is used for some early stage tumors. Cryotherapy (the process of freezing the tumor), hormonal therapy, and chemotherapy may also be offered if initial treatment fails and the cancer progresses.

Castration-resistant prostate cancer

Most hormone dependent cancers become refractory after one to three years and resume growth despite hormone therapy. Previously considered “hormone-refractory prostate cancer” or “androgen-independent prostate cancer”, the term castration-resistant has replaced “hormone refractory” because while they are no longer responsive to castration treatment (reduction of available androgen/testosterone/DHT by chemical or surgical means), these cancers still show reliance upon hormones for androgen receptor activation. Before 2004, all treatments for castration-resistant prostate cancer (CRPC) were consideredpalliative and not shown to prolong survival. However, there are now several treatments available to treat CRPC that improve survival.

The cancer chemotherapic docetaxel has been used as treatment for (CRPC) with a median survival benefit of 2 to 3 months. Docetaxel’s FDA approval in 2004 was significant as it was the first treatment proven to prolong survival in CRPC. In 2010, the FDA approved a second-line chemotherapy treatment known as cabazitaxel.

Off-label use of the oral drug ketoconazole is sometimes used as a way to further manipulate hormones with a therapeutic effect in CRPC. However, many side effects are possible with this drug and abiraterone is likely to supplant usage since it has a similar mechanism of action with less toxic side effects.

A combination of bevacizumab (Avastin), docetaxel, thalidomide and prednisone appears effective in the treatment of CRPC.

The immunotherapy treatment with sipuleucel-T is also effective in the treatment of CRPC with a median survival benefit of 4.1 months.

The second line hormonal therapy abiraterone (Zytiga) completed a phase 3 trial for CRPC patients who have failed chemotherapy in 2010. Results were positive with overall survival increased by 4.6 months when compared to placebo. On April 28, 2011, the U.S. Food and Drug Administration approved abiraterone acetate in combination with prednisone to treat patients with late-stage (metastatic) castration-resistant prostate cancer who have received prior docetaxel (chemotherapy).

Experimental

Alpharadin completed a phase 3 trial for CRPC patients with bone metastasis. A pre-planned interim analysis showed improved survival and quality of life. The study was stopped for ethical reasons to give the placebo group the same treatment. Apharadin uses bone targeted Radium-223 isotopes to kill cancer cells by alpha radiation. Alpharadin is an investigational agent and is not approved for marketing by the European Medicines Agency (EMA), the U.S. Food and Drug Administration (FDA), or any other health authorities.

There are also several treatments currently in clinical trials to treat CRPC. These include the 2nd generation hormonal therapies MDV3100 and orteronel (TAK-700), the immunotherapy PROSTVAC, the clusterin protein inhibitor OGX-011, and the bone metastasis-targeting cabozantinib (XL-184). Tasquinimod had good results in a phase II trial.

Prognosis

Prostate cancer rates are higher and prognoses are poorer in developed countries than the rest of the world. Many of the risk factors for prostate cancer are more prevalent in the developed world, including longer life expectancy and diets high in red meat. (People who consume larger amounts of meat and dairy also tend to consume fewer portions of fruits and vegetables. It is not currently clear whether both of these factors, or just one of them, contribute to the occurrence of prostate cancer.) Also, where there is more access to screening programs, there is a higher detection rate. Prostate cancer is the ninth-most-common cancer in the world, but is the number-one non-skin cancer in men from the United States. Prostate cancer affected eighteen percent of American men and caused death in three percent in 2005. In Japan, death from prostate cancer was one-fifth to one-half the rates in the United States and Europe in the 1990s. In India in the 1990s, half of the people with prostate cancer confined to the prostate died within ten years. African-American men have 50–60 times more prostate cancer and prostate cancer deaths than men in Shanghai, China. In Nigeria, two percent of men develop prostate cancer, and 64% of them are dead after two years.

In patients who undergo treatment, the most important clinical prognostic indicators of disease outcome are stage, pre-therapy PSA level, and Gleason score. In general, the higher the grade and the stage, the poorer the prognosis. Nomograms can be used to calculate the estimated risk of the individual patient. The predictions are based on the experience of large groups of patients suffering from cancers at various stages.

In 1941, Charles Huggins reported that androgen ablation therapy causes regression of primary and metastatic androgen-dependent prostate cancer. He was awarded the 1966 Nobel Prize for Physiology or Medicine for this discovery. Androgen ablation therapy causes remission in 80-90% of patients undergoing therapy, resulting in a median progression-free survival of 12 to 33 months. After remission, an androgen-independent phenotype typically emerges, wherein the median overall survival is 23–37 months from the time of initiation of androgen ablation therapy. The actual mechanism contributes to the progression of prostate cancer is not clear and may vary between individual patient. A few possible mechanisms have been proposed.

Classification systems

Many prostate cancers are not destined to be lethal, and most men will ultimately die from causes other than of the disease. Decisions about treatment type and timing may, therefore, be informed by an estimation of the risk that the tumor will ultimately recur after treatment and/or progress to metastases and mortality. Several tools are available to help predict outcomes, such as pathologic stage and recurrence after surgery or radiation therapy. Most combine stage, grade, and PSA level, and some also add the number or percent of biopsy cores positive, age, and/or other information.

  • The D’Amico classification stratifies men by low, intermediate, or high risk based on stage, grade, and PSA. It is used widely in clinical practice and research settings. The major downside to the 3-level system is that it does not account for multiple adverse parameters (e.g., high Gleason score and high PSA) in stratifying patients.
  • The Partin tables predict pathologic outcomes (margin status, extraprostatic extension, and seminal vesicle invasion) based on the same three variables and are published as lookup tables.
  • The Kattan nomograms predict recurrence after surgery and/or radiation therapy, based on data available either at time of diagnosis or after surgery. The nomograms can be calculated using paper graphs or software available on a website or for handheld computers. The Kattan score represents the likelihood of remaining free of disease at a given time interval following treatment.
  • The UCSF Cancer of the Prostate Risk Assessment (CAPRA) score predicts both pathologic status and recurrence after surgery. It offers comparable accuracy as the Kattan preoperative nomogram, and can be calculated without paper tables or a calculator. Points are assigned based on PSA, Grade, stage, age, and percent of cores positive; the sum yields a 0–10 score, with every 2 points representing roughly a doubling of risk of recurrence. The CAPRA score was derived from community-based data in the CaPSURE database. It has been validated among over 10,000 prostatectomy patients, including patients from CaPSURE; the SEARCH registry, representing data from several Veterans Administration and active military medical centers; a multi-institutional cohort in Germany; and the prostatectomy cohort at Johns Hopkins University. More recently, it has been shown to predict metastasis and mortality following prostatectomy, radiation therapy, watchful waiting, or androgen deprivation therapy.

Society and culture

Discrimination

People with prostate cancer generally encounter significant disparities in awareness, funding, media coverage, and research—and therefore, inferior treatment and poorer outcomes—compared to other cancers of equal prevalence. In 2001 The Guardian noted that Britain had 3,000 nurses specializing in breast cancer, compared to only one for prostate cancer. It also discovered that the waiting time between referral and diagnosis was two weeks for breast cancer but three months for prostate cancer. A 2007 report by The National Prostate Cancer Coalition stated that for every prostate cancer drug on the market, there were seven used to treat breast cancer. The Times also noted an “anti-male bias in cancer funding” with a four to one discrepancy in the United Kingdom by both the government and by cancer charities such as Cancer Research UK. Equality campaigners such as author Warren Farrell cite such stark spending inequalities as a clear example of governments unfairly favouring women’s health over men’s health.

Disparities also extend into areas such as detection, with governments failing to fund or mandate prostate cancer screening while fully supporting breast cancer programs. For example, a 2007 report found 49 U.S. states mandate insurance coverage for routine breast cancer screening, compared to 28 for prostate cancer. Prostate cancer also experiences significantly less media coverage than other, equally prevalent cancers, with a study by Prostate Coalition showing 2.6 breast cancer stories for each one covering cancer of the prostate.

History

Although the prostate was first described by Venetian anatomist Niccolò Massa in 1536, and illustrated by Flemish anatomist Andreas Vesalius in 1538, prostate cancer was not identified until 1853. Prostate cancer was initially considered a rare disease, probably because of shorter life expectancies and poorer detection methods in the 19th century. The first treatments of prostate cancer were surgeries to relieve urinary obstruction. Removal of the entire gland (radical perineal prostatectomy) was first performed in 1904 by Hugh H. Young at Johns Hopkins Hospital. Surgical removal of the testes (orchiectomy) to treat prostate cancer was first performed in the 1890s, but with limited success. Transurethral resection of the prostate (TURP) replaced radical prostatectomy for symptomatic relief of obstruction in the middle of the 20th century because it could better preserve penile erectile function. Radical retropubic prostatectomy was developed in 1983 by Patrick Walsh. This surgical approach allowed for removal of the prostate and lymph nodes with maintenance of penile function.

In 1941, Charles B. Huggins published studies in which he used estrogen to oppose testosterone production in men with metastatic prostate cancer. This discovery of “chemical castration” won Huggins the 1966 Nobel Prize in Physiology or Medicine. The role of the hormone GnRH in reproduction was determined by Andrzej W. Schally and Roger Guillemin, who both won the 1977 Nobel Prize in Physiology or Medicine for this work.

GnRH receptor agonists, such as leuprolide and goserelin, were subsequently developed and used to treat prostate cancer.

Radiation therapy for prostate cancer was first developed in the early 20th century and initially consisted of intraprostatic radium implants. External beam radiotherapy became more popular as stronger [X-ray] radiation sources became available in the middle of the 20th century. Brachytherapy with implanted seeds (for prostate cancer) was first described in 1983.

Systemic chemotherapy for prostate cancer was first studied in the 1970s. The initial regimen of cyclophosphamide and 5-fluorouracil was quickly joined by multiple regimens using a host of other systemic chemotherapy drugs.

Cell-of-origin

On 30 July 2010 Owen Witte M.D. et al. of UCLA published a series of studies in Science during which they had introduced viruses known to cause cancerous mutation in prostate cells: AKT, ERG, and AR into isolated samples of basal and luminal cells and grafted the treated tissue into mice. After 16 weeks, none of the luminal samples had undergone malignant mutation, while the basal samples had mutated into prostate-like tubules which had then developed malignancy and formed cancerous tumors, which appeared identical to human samples under magnification. This led to the conclusion that the prostate basal cell may be the most likely “site of origin” of prostate cancer.

Capter III:

“Closing”

3.1 Conclusion

Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease.

3.2 Sugesstion

so We have to keep in good health the us from prostate cancer especially to all man, whilst we still be young. We don’t waste in our body for the things of which of no use to a period of/to to come. Because life only 1 times and will not return for the things at twice if just to make we suffered later on day.

 

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