Prostate cancer (patient information)

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 * Associate Editor-In-Chief: Jinhui Wu, M.D., Ujjwal Rastogi, MBBS

Overview
Prostate cancer is the third leading-cause of death in men of all ages. It is a malignant tumor that begins in the prostate gland of men which produces fluid for semen. More than 95% of prostate cancers are adenocarcinomas, cancer that develops in glandular tissue. Some prostate cancers grow very slowly and may cause no symptom or problem for several years. However, if cancer does metastasize to other organs, it may cause pain (especially bone pain), fatigue, and other symptoms. For prostate cancer, levels of prostate specific antigen (PSA) is the main marker to diagnose and detect after treatment. Prostate cancer treatment often depends on the stage of the cancer. Treatment may include surgery, radiation therapy, chemotherapy or control of hormones that affect the cancer.

What are the symptoms of Prostate cancer?
Early prostate cancer does not make any symptoms. When the cancer grows larger or spreads, people may notice one or more symptoms as the following.


 * Weak or interrupted urine flow
 * Frequent urination
 * The urge to urinate frequently at night
 * Hematuria (blood in the urine)
 * Hematospermia (blood in the seminal fluid)
 * Pain or burning during urination (much less common)

other health problems such as benign prostatic hyperplasia (BPH) may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that problems can be diagnosed and treated as early as possible.

If cancer has spread, a man may experience:
 * Bone pain in the back, hips, thighs, shoulders, or in other bones
 * Unexplained weight loss
 * Fatigue
 * Other symptoms, depending on the location

What causes Prostate cancer?
Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.

Who is at highest risk?
People who are at higher risk include:

African-American men, who are also likely to develop cancer at every age Men who are older than 60 Men who have a father or brother with prostate cancer Other people at risk include:

Men exposed to agent orange exposure Men who abuse alcohol Farmers Men who eat a diet high in fat, especially animal fat Tire plant workers Painters Men who have been exposed to cadmium The lowest number of cases occurs in Japanese men living in Japan (this benefit is lost after one generation of living in the U.S.) and those who do not eat meat (vegetarians).

A common problem in almost all men as they grow older is an enlarged prostate (benign prostatic hyperplasia, or BPH). This problem does not raise your risk of prostate cancer.

Risk factor that you can change Many studies have indicated bad diet habits are associated with prostate cancer. Although there is not enough data yet to make clear recommendations on the role diet plays in prostate cancer, the following may be harmful:
 * A diet high in fat, especially animal fat
 * A diet low in vegetables, fruits, and legumes
 * Food low or deficient in Selenium

When to seek urgent medical care?
Call your health care provider if symptoms of gastric cancer develop. If one emerges the following symptoms, seeking urgent medical care as soon as possible:
 * Hematuria
 * Hematospermia (blood in the seminal fluid)

Diagnosis
It is hard to diagnose prostate cancer in its early stages because some grow very slowly and may cause no symptom or problem for several years. However, if cancer does metastasize to other organs, it may cause pain (especially bone pain), fatigue, and other symptoms. So, if you have those symptoms, you had better go to see the doctor to do some tests. The tests include lab tests, especially PSA test, and image tests and endoscopy.
 * PSA (prostate-specific antigen) and Free-PSA test: PSA is a tumor marker which is released by prostate tissue and used to detect whether there is any abnomoral activity in the prostate, such as prostate cancer, BPH, or prostatitis. Patients with prostate cancer can be detects higher levels than normal. Doctors can look at features of the PSA value and level in relation to prostate size to determine if a biopsy is needed.
 * Digital rectal examination (DRE): In this test, the doctor inserts a gloved finger into the anus to feel for the surface of the prostate.
 * Transrectal ultrasound (TRUS): During this test, the doctor inserts a probe into the rectum in order to obtain a picture of the prostate by sound waves that reflected from the prostate.
 * Biopsy: It is the most definite diagnosis method. The surgeon uses a biopsy tool to take very small slivers of prostate tissue which will be analyzed by a pathologist.
 * Computed tomography (CT) scan: This computer scan can combine a three-dimensional images into a detailed, cross-sectional view which shows any abnormalities or tumors. Usually, a contrast medium is injected into a patient’s vein to provide clearer detail. It can confirm the location of the cancer and show the organs near the prostate, as well as lymph nodes and distant organs where the cancer might have spread. These are helpful in staging the cancer.
 * Magnetic resonance imaging (MRI): An MRI uses magnetic fields but which is a different imaging type from computed tomography (CT) to produce detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.
 * Whole Bone Scan (WBS): The aim of this test is to determine whether the bone pain is metastatic tumor of bone or not. It is used a radioactive tracer which is injected into your vein to look at the inside of the bones.

Treatment options
Patients with prostate cancer have many treatment options. The options are surgery, radiation therapy, hormone therapy, or a combination of methods. Before treatment starts, ask your health care team about possible side effect and how treatment may change your normal activities.

Surgery: Surgery involves removal of the whole prostate and accompanying seminal vesicles and possibly lymph nodes in the pelvic area. The type of surgery depends on the stage of the disease, the man’s general health, and other factors. The following are common surgical methods:
 * Radical prostatectomy
 * Laparoscopic prostatectomy
 * Transurethral resection of the prostate (TURP)
 * Cryosurgery: Most commonly are used in experimental studies.

Radiation therapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. It includes:
 * External-beam radiation therapy
 * Intensity-modulated radiation therapy (IMRT)
 * Brachytherapy

Hormone therapy: Hormone treatment also called androgen ablation or androgen deprivation therapy is to turn off the function of the testicles by using androgen such as testosterone or by surgery or by surgical castration. One important complication of hormonal therapy is the risk of developing metabolic syndrome such as high levels of blood cholesterol, high blood pressure that place a person at high risk of heart disease, stroke, and diabetes. This treatment includes:
 * Bilateral orchiectomy
 * LHRH (luteinizing hormone-releasing hormone) agonists
 * Anti-androgens
 * Female hormones
 * Combined androgen blockade

Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing.

Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Where to find medical care for Prostate cancer?
Directions to Hospitals Treating prostate cancer

What to expect (Outlook/Prognosis)?
The prognosis of prostate cancer depends on the stage of the cancer, PSA level and Gleason score. The factors are following:


 * Patients's general health
 * The level of PSA
 * The stage of the prostate cancer
 * Whether or not the tumor can be removed by surgery
 * Whether the cancer has just been diagnosed or has recurred

Possible complications
The complications of prostate cancer are mostly due to different treatments.

Prevention
Many clinical researches have indicated bad diet habits are associated with prostate cancer. Epidemiology data show the following intervention may help to reduce your risk of prostate cancer:
 * Healthy diets high in vegetables, fruits, and legumesand low in fat, especially animal fat
 * Food rich in Selenium