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Encyclopedia > Prostate cancer
Prostate cancer
Classification and external resources
ICD-10 C61.
ICD-9 185
OMIM 176807
DiseasesDB 10780
MedlinePlus 000380
eMedicine radio/574 

Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms. The Hudson River Psychiatric Center, originally the Hudson River State Hospital, is a former New York state psychiatric hospital whose main building has been designated a National Historic Landmark due to its exemplary High Victorian Gothic architecture, the first use of that style for an American institutional building. ... Image File history File linksMetadata Prostatelead. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // C00-D48 - Neoplasms (C00-C14) Malignant neoplasms, lip, oral cavity and pharynx (C00) Malignant neoplasm of lip (C01) Malignant neoplasm of base of tongue (C02) Malignant neoplasm of other and unspecified parts of tongue (C03) Malignant neoplasm of gum (C04) Malignant neoplasm of floor of mouth (C05) Malignant neoplasm of... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... This article is about the medical term. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... The prostate is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. ... This article is about the Male sex. ... A pictorial illustration of the human female reproductive system. ... Drawing of the structure of cork as it appeared under the microscope to Robert Hooke from Micrographia which is the origin of the word cell being used to describe the smallest unit of a living organism Cells in culture, stained for keratin (red) and DNA (green) The cell is the... For linguistic mutation, see Apophony. ... For the musical composition, see Metastasis (Xenakis composition). ... This article is about the skeletal organs. ... Lymph nodes are components of the lymphatic system. ... Manneken Pis of Brussels. ... Erectile dysfunction (ED) or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. ... The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: A symptom can be a physical condition which shows that one has a particular illness or disorder (see e. ...


Rates of prostate cancer vary widely across the world. Although the rates vary widely between countries, it is least common in South and East Asia, more common in Europe, and most common in the United States.[1] According to the American Cancer Society, prostate cancer is least common among Asian men and most common among black men, with figures for white men in-between.[2][3] However, these high rates may be affected by increasing rates of detection.[4] The American Cancer Society (ACS) is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy and service. ...


Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except lung cancer. In the UK it is also the second most common cause of cancer death after lung cancer. Around 35,000 men in the UK are diagnosed per year; where around 10,000 die of it. However, many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. That is because malignant neoplasms of the prostate are, in most cases, slow-growing, and because most of those affected are very old. Hence they often die of causes unrelated to the prostate cancer, such as heart/circulatory disease, pneumonia, other unconnected cancers or old age. Many factors, including genetics and diet, have been implicated in the development of prostate cancer. Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. ... This article is about the general scientific term. ... In nutrition, the diet is the sum of food consumed by a person or other organism. ...


Prostate cancer is most often discovered by physical examination or by screening blood tests, such as the PSA (prostate specific antigen) test. There is some current concern about the accuracy of the PSA test and its usefulness. Suspected prostate cancer is typically confirmed by removing a piece of the prostate (biopsy) and examining it under a microscope. Further tests, such as X-rays and bone scans, may be performed to determine whether prostate cancer has spread. In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Prostate specific antigen (PSA) is a protein produced by the cells of the prostate gland. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... A microscope (Greek: (micron) = small + (skopein) = to look at) is an instrument for viewing objects that are too small to be seen by the naked or unaided eye. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... Drawing shows patient lying on a table that slides under the scanner, a technician operating the scanner, and a monitor that will show images made during the scan. ...


Prostate cancer can be treated with surgery, radiation therapy, hormonal therapy, occasionally chemotherapy, proton therapy, or some combination of these. The age and underlying health of the man as well as the extent of spread, appearance under the microscope, and response of the cancer to initial treatment are important in determining the outcome of the disease. Since prostate cancer is a disease of older men, many will die of other causes before a slowly advancing prostate cancer can spread or cause symptoms. This makes treatment selection difficult.[5] 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. “Surgeon” redirects here. ... Varian Clinac 2100C Linear Accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Hormonal therapy is one of the major modalities of medical treatment for cancer, others being cytotoxic chemotherapy and targeted therapy (biotherapeutics). ... Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. ... Proton therapy is a kind of external beam radiotherapy where protons are directed to a tumor site. ... The trade-off dilemma in prostate cancer treatment refers to the choice between different treatments for localized prostate cancer (a tumor that is contained within the prostate). ...

Contents

Prostate

Main article: Prostate

The prostate is a part of the male reproductive organ which helps make and store seminal fluid. In adult men a typical prostate is about three centimeters long and weighs about twenty grams.[6] 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.[7] 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.[8] 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. The prostate is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. ... The prostate is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. ... A pictorial illustration of the human female reproductive system. ... This article is about the biological unit. ... Male Anatomy The prostate is a gland that is part of male mammalian sex organs. ... The pelvis (pl. ... This article is about the urinary bladder. ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ... In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ... This article is about the urine of animals generally. ... Manneken Pis of Brussels. ... Ejaculation is the ejecting of semen from the penis, and is usually accompanied by orgasm. ... Anatomy of the anus and rectum For the death metal band Defecation, see Defecation (band). ... Human submaxillary gland. ... For linguistic mutation, see Apophony. ... For other uses, see Hormone (disambiguation). ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Testosterone is a steroid hormone from the androgen group. ... Human male anatomy The testicles, known medically as testes (singular testis), are the male generative glands in animals. ... Dehydroepiandrosterone (DHEA), is a natural steroid prohormone produced from cholesterol by the adrenal glands, the gonads, adipose tissue, brain and in the skin (by an autocrine mechanism)]. DHEA is the precursor of androstenedione, testosterone and estrogen. ... In mammals, the adrenal glands (also known as suprarenal glands) are the triangle-shaped endocrine glands that sit on top of the kidneys; their name indicates that position (ad-, near or at + -renes, kidneys). They are chiefly responsible for regulating the stress response through the synthesis of corticosteroids and catecholamines... For other uses, see DHT (disambiguation). ... A peacock displays his long, colored feathers, an example of his secondary sexual characteristics. ...


Symptoms

Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hypertrophy. These include frequent urination, increased urination at night, difficulty starting and maintaining a steady stream of urine, blood in the urine, and painful urination. Prostate cancer is associated with urinary disfunction as the prostate gland surrounds the prostatic urethra. Changes within the gland therefore directly affect urinary function. Prostate cancer may also cause problems with sexual function, such as difficulty achieving erection or painful ejaculation.[9] The Vas deferens deposits seminal fluid into the prostatic urethra and secretions from the prostate gland itself are included in semen content, which is why Prosate Cancer can affect sexual performance and cause painful ejaculation. Prostate specific antigen (PSA) is a protein produced by the cells of the prostate gland. ... Benign prostatic hyperplasia (BPH) is the increase in size of the prostate in middle_aged and elderly men. ... Polyuria is the passage of a large volume of urine in a given period. ... Nocturia is the need to get up during the night in order to urinate, thus interrupting sleep. ... In medicine, hematuria (or haematuria) is the presence of blood in the urine. ... In medicine, specifically urology, dysuria refers to any difficulty in urination. ... This article is about human physiological erection. ... Ejaculation is the ejecting of semen from the penis, and is usually accompanied by orgasm. ... The vas deferens (plural: vasa deferentia), also called ductus deferens, (Latin: carrying-away vessel) is part of the male anatomy of some species, including humans. ...


Advanced prostate cancer can spread to other parts of the body and this may cause additional symptoms. The most common symptom being bone pain, often in 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.[10] Bone Pain- Bone pain is generally referred to as having pain within the affected bone. ... A diagram of a thoracic vertebra. ... The pelvis (pl. ... The human rib cage. ... The femur or thigh bone is the longest, most voluminous, and strongest bone of the mammalian bodies. ... The vertebral column seen from the side Different regions (curvatures) of the vertebral column The vertebral column (backbone or spine) is a column of vertebrae situated in the dorsal aspect of the abdomen. ... The Spinal cord nested in the vertebral column. ... The tone or style of this article or section may not be appropriate for Wikipedia. ... Fecal incontinence is the loss of regular control of the bowels. ...


Pathophysiology

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 which 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, rectum, and bladder. This image has been released into the public domain by the copyright holder, its copyright has expired, or it is ineligible for copyright. ... This image has been released into the public domain by the copyright holder, its copyright has expired, or it is ineligible for copyright. ... A section of mouse liver showing an apoptotic cell indicated by an arrow Apoptosis (pronounced apo tō sis) is a process of suicide by a cell in a multicellular organism. ... Adenocarcinoma is a form of carcinoma that originates in glandular tissue. ... For linguistic mutation, see Apophony. ... Carcinoma in situ is present when a tumor has been detected that has the characteristics of malignancy but has not invaded other tissues. ... Prostatic intraepithelial neoplasia (PIN) is a precancerous lesion in the prostate gland which is a precursor of prostate cancer. ... Stroma can refer to: The connective supportive framework of a biological cell, tissue, or organ. ... For malignant tumors specifically, see cancer. ... Categories: Stub | Andrology | Exocrine system | Reproductive system ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ... For other uses, see Blood (disambiguation). ... The lymphatic system is a complex network of lymphoid organs, lymph nodes, lymph ducts, lymphatic tissues, lymph capillaries and lymph vessels that produce and transport lymph fluid from tissues to the circulatory system. ... In medicine, malignant is a clinical term that means to be severe and become progressively worse, as in malignant hypertension. ... For the musical composition, see Metastasis (Xenakis composition). ... This article is about the skeletal organs. ... Lymph nodes are components of the lymphatic system. ...


Etiology

The specific causes of prostate cancer remain unknown.[11] A man's risk of developing prostate cancer is related to his age, genetics, race, diet, lifestyle, medications, and other factors. The primary risk factor is age. Prostate cancer is uncommon in men less than 45, but becomes more common with advancing age. The average age at the time of diagnosis is 70.[12] 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.[13] In the year 2005 in the United States, there were an estimated 230,000 new cases of prostate cancer and 30,000 deaths due to prostate cancer.[14] Ageing or aging is the process of getting older. ... This article is about the general scientific term. ... For other uses, see Race. ... In nutrition, the diet is the sum of food consumed by a person or other organism. ... This article does not cite any references or sources. ...


A man's genetic background contributes to his risk of developing prostate cancer. This is suggested by an increased incidence of prostate cancer found in certain racial groups, in identical twins of men with prostate cancer, and in men with certain genes. In the United States, prostate cancer more commonly affects black men than white or Hispanic men, and is also more deadly in black men.[15] Men who have a brother or father with prostate cancer have twice the usual risk of developing prostate cancer.[16] Studies of twins in Scandinavia suggest that forty percent of prostate cancer risk can be explained by inherited factors.[17] However, no single gene is responsible for prostate cancer; many different genes have been implicated. Two genes (BRCA1 and BRCA2) that are important risk factors for ovarian cancer and breast cancer in women have also been implicated in prostate cancer.[18] Incidence is a measure of the risk of developing some new condition within a specified period of time. ... For other uses, see Twin (disambiguation). ... For other uses, see Gene (disambiguation). ... Twin studies are one of a family of designs in behavior genetics which aid the study of individual differences by highlighting the role of environmental and genetic causes on behavior. ... For other uses, see Scandinavia (disambiguation). ... In genetics, heritability is the proportion of phenotypic variation in a population that is attributable to genetic variation among individuals. ... BRCA1 (breast cancer 1, early onset) is a human gene that belongs to a class of genes known as tumor suppressors, which regulate the cell cycle and prevent uncontrolled proliferation. ... BRCA2 refers to either a gene (BReast-CAncer susceptibility gene 2, located on human chromosome 13, 13q12-13) or the protein coded for by that gene. ... Ovarian cancer is a malignant tumor (a kind of neoplasm) located on an ovary. ... Breast cancer is cancer of breast tissue. ...


Dietary amounts of certain foods, vitamins, and minerals can contribute to prostate cancer risk. Men with higher serum levels of the short-chain ω-6 fatty acid linoleic acid have higher rates of prostate cancer. However, the same series of studies showed that men with elevated levels of long-chain ω-3 (EPA and DHA) had lowered incidence.[19] A long-term study reports that "blood levels of trans fatty acids, in particular trans fats resulting from the hydrogenation of vegetable oils, are associated with an increased prostate cancer risk."[20] Other dietary factors that may increase prostate cancer risk include low intake of vitamin E (Vitamin E is found in green, leafy vegetables), omega-3 fatty acids (found in fatty fishes like salmon), and the mineral selenium. A study in 2007 cast doubt on the effectiveness of lycopene (found in tomatoes) in reducing the risk of prostate cancer.[21] Lower blood levels of vitamin D also 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.[22] Retinol (one vitamer of Vitamin A) A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. ... mccall is cooool Dietary minerals are the chemical elements required by living organisms, other than the four elements carbon, hydrogen, nitrogen, and oxygen which are present in common organic molecules. ... Omega-6 fatty acids are fatty acids where the term omega-6 signifies that the first double bond in the carbon backbone of the fatty acid, counting from the end opposite the acid group, occurs in the sixth carbon-carbon bond. ... Linoleic acid (LA) is an unsaturated omega-6 fatty acid. ... Eicosapentaenoic acid (EPA or also icosapentaenoic acid) is an omega-3 fatty acid. ... Docosahexaenoic acid (commonly known as DHA; 22:6(ω-3), all-cis-docosa-4,7,10,13,16,19-hexaenoic acid; trivial name cervonic acid) is an omega-3 essential fatty acid. ... A trans fatty acid (commonly shortened to trans fat) is an unsaturated fatty acid molecule that contains a trans double bond between carbon atoms, which makes the molecule less kinked compared to cis fat. Research suggests a correlation between diets high in trans fats and diseases like atherosclerosis and coronary... Tocopherol, or Vitamin E, is a fat-soluble vitamin in eight forms that is an important antioxidant. ... Fresh Swiss chard Fresh water spinach Creamed spinach Steamed kale Leaf vegetables, also called potherbs, greens, or leafy greens, are plant leaves eaten as a vegetable, sometimes accompanied by tender petioles and shoots. ... For an explanation of n and numerical nomenclature (such as n−3 or 18:3), see Nomenclature of fatty acids. ... For other uses, see Salmon (disambiguation). ... For other uses, see Selenium (disambiguation). ... Lycopene is a bright red carotenoid pigment, a phytochemical found in tomatoes and other red fruits. ... For other uses, see Blood (disambiguation). ... Vitamin D is a fat soluble vitamin that contributes to the maintenance of normal levels of calcium and phosphorus in the bloodstream. ... Note: Ultraviolet is also the name of a 1998 UK television miniseries about vampires. ...


There are also some links between prostate cancer and medications, medical procedures, and medical conditions. Daily use of anti-inflammatory medicines such as aspirin, ibuprofen, or naproxen may decrease prostate cancer risk.[23] Use of the cholesterol-lowering drugs known as the statins may also decrease prostate cancer risk.[24] More frequent ejaculation also may decrease a man's risk of prostate cancer. One study showed that men who ejaculated five times a week in their 20s had a decreased rate of prostate cancer, though others have shown no benefit. [25][26] Infection or inflammation of the prostate (prostatitis) may increase the chance for prostate cancer. In particular, infection with the sexually transmitted infections chlamydia, gonorrhea, or syphilis seems to increase risk.[27] Finally, obesity[28] and elevated blood levels of testosterone[29] may increase the risk for prostate cancer. Wikipedia does not yet have an article with this exact name. ... This article is about the drug. ... Ibuprofen (INN) (IPA: ) (from the earlier nomenclature iso-butyl-propanoic-phenolic acid) is a non-steroidal anti-inflammatory drug (NSAID) originally marketed as Nurofen and since under various trademarks, including Act-3, Advil, Brufen, Dorival, Herron Blue, Panafen, Motrin, Nuprin and Burana (Finland), Ipren or Ibumetin (Denmark and Sweden), Ibuprom... Naproxen (trade names: Aleve, Anaprox, Naprosyn, Naprelan) is a non-steroidal anti-inflammatory drug commonly used for the reduction of mild to moderate pain, fever, inflammation and stiffness caused by conditions such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis, injury, menstrual cramps, tendinitis, bursitis, and the treatment of... The hypolipidaemic agents are a diverse group of pharmaceuticals that are used in treatment of hyperlipidemias. ... Lovastatin, the first statin to be marketed The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic drugs used to lower cholesterol levels in people with or at risk of cardiovascular disease. ... An infection is the detrimental colonization of a host organism by a foreign species. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Prostatitis is any form of inflammation of the prostate gland. ... Sexually-transmitted infections (STIs), also known as sexually-transmitted diseases (STDs), are diseases that are commonly transmitted between partners through some form of sexual activity, most commonly vaginal intercourse, oral sex, or anal sex. ... Chlamydia is a common term for Chlamydiae. ... The clap redirects here. ... Syphilis is a curable sexually transmitted disease caused by the Treponema pallidum spirochete. ... Testosterone is a steroid hormone from the androgen group. ...


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.[30] For other uses, see Agent Orange (disambiguation). ...


Prostate cancer risk can be decreased by modifying known risk factors for prostate cancer, such as decreasing intake of animal fat.[31]


One research study, by the Cancer Council Victoria, has shown that men who report that they regularly ("more than five times per week") masturbate have up to one third fewer occurrences of prostate cancer.[32][25] The researchers hypothesize that this could be because regular ejaculation reduces the buildup of carcinogenic deposits such as 3-methylcholanthrene is produced from the breakdown of cholesterol, which could damage the cells lining the prostate. The researchers also speculated that frequent ejaculation may cause the prostate to mature fully, making it less susceptible to carcinogens. It is also possible that there is another factor (such as hormone levels) that is a common cause of both a reduced susceptibility to prostate cancer and a tendency toward frequent masturbation. There is also some evidence that frequent sexual intercourse is associated with reduced risk of prostate cancer, although contrarily the risks associated with STDs have been shown to increase the risk of prostate cancer.[32][25] Once the lining of the prostate is affected with cancer, the only known treatments are surgery and radiation therapy. Both may limit the ability to have erections afterward. The Cancer Council Australia is a national, private organization which aims to promote cancer-control policies and to reduce the illness caused by cancer in Australia. ... Woman masturbating, 1913 drawing by Gustav Klimt. ... Look up Hypothesis in Wiktionary, the free dictionary. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Categories: Chemistry stubs | Carcinogens | Polycyclic aromatic hydrocarbons ... Correlation does not imply causation is a phrase used in the sciences and statistics to emphasize that correlation between two variables does not imply there is a cause-and-effect relationship between the two. ...


Prevention

Several medications and vitamins may also help prevent prostate cancer. Two dietary supplements, vitamin E and selenium, may help prevent prostate cancer when taken daily. Estrogens from fermented soybeans and other plant sources (called phytoestrogens) may also help prevent prostate cancer.[33] The selective estrogen receptor modulator drug toremifene has shown promise in early trials.[34][35] Two medications which block the conversion of testosterone to dihydrotestosterone, finasteride[36] and dutasteride,[37] 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. The problem with these medications is that they may preferentially block the development of lower-grade prostate tumors, leading to a relatively greater chance of higher grade cancers, and negating any overall survival improvement. Green tea may be protective (due to its polyphenol content), though the data is mixed.[38][39] A 2006 study of green tea derivatives demonstrated promising prostate cancer prevention in patients at high risk for the disease.[40] In 2003, an Australian research team led by Graham Giles of The Cancer Council Australia concluded that frequent masturbation by males appears to help prevent the development of prostate cancer.[32] Recent research published in the Journal of the National Cancer Institute suggests that taking multivitamins more than seven times a week can increase the risks of contracting the disease.[41][42] 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. Scientists recommend a healthy, well balanced diet rich in fiber, and to reduce intake of meat. A 2007 study published in the Journal of the National Cancer Institute found that men eating cauliflower, broccoli, or one of the other cruciferous vegetables, more than once a week were 40% less likely to develop prostate cancer than men who rarely ate those vegetables.[43][44] Scientists believe the reason for this phenomenon has to do with a phytochemical called Diindolylmethane in these vegetables that has Anti-Androgenic and immune modulating properties. This compound is currently under investigation by the National Cancer Institute as a natural therapeutic for prostate cancer. Australian research concluded that the more men ejaculate between the ages of 20 and 50, the less likely they are to develop prostate cancer. The protective effect is greatest while men are in their twenties: those who had ejaculated more than five times per week in their twenties, for instance, were one-third less likely to develop aggressive prostate cancer later in life. The results contradict those of previous studies, which have suggested that having had many sexual partners, or a high frequency of sexual activity, increases the risk of prostate cancer by up to 40 per cent. The key difference is that these earlier studies defined sexual activity as sexual intercourse, whereas the latest study focused on the number of ejaculations, whether or not intercourse was involved.[45] Tocopherol, or Vitamin E, is a fat-soluble vitamin in eight forms that is an important antioxidant. ... For other uses, see Selenium (disambiguation). ... Binomial name Glycine max Soybeans (US) or soya beans (UK) (Glycine max) are a high-protein legume (Family Fabaceae) grown as food for both humans and livestock. ... Phytoestrogens are plant compounds with effects similar to those of estrogen, although somewhat weaker. ... Selective estrogen receptor modulators (SERMs) is a class of medication that acts on the estrogen receptor. ... Toremifene is an oral selective estrogen receptor modulator (SERM) which helps oppose the actions of estrogen in the body. ... Testosterone is a steroid hormone from the androgen group. ... For other uses, see DHT (disambiguation). ... Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is an antiandrogen which acts by inhibiting type II 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT). ... Dutasteride inhibits the conversion of testosterone into dihydrotestosterone. ... Green tea (绿茶) is tea that has undergone minimal oxidation during processing. ... Polyphenols are a group of chemical substances found in plants, characterized by the presence of more than one phenol unit or building block per molecule. ... Woman masturbating, 1913 drawing by Gustav Klimt. ... The National Cancer Institute (NCI) is part of the United States Federal governments National Institutes of Health. ... A multivitamin is any preparation containing more than a single vitamin. ... Cauliflower within Brassica oleracea, in the family Brassicaceae. ... Broccoli is a plant of the Cabbage family, Brassicaceae (formerly Cruciferae). ... Cabbage plants Edible plants in the family Brassicaceae (also called Cruciferae) are termed Cruciferous vegetables. ... Phytochemicals are plant or fruit derived chemical compounds. ... 3,3-Diindolylmethane or DIM is derived from the digestion of indole-3-carbinol, found in Brassica vegetables such as broccoli and cauliflower. ... An antiandrogen, or androgen antagonist, is any of a group of hormone antagonist compounds that are capable of preventing or inhibiting the biologic effects of androgens, male sex hormones, on normally responsive tissues in the body (see androgen insensitivity syndrome). ...


Screening

Prostate cancer screening is an attempt to find unsuspected cancers. Screening tests may lead to more specific follow-up tests such as a biopsy, where small pieces of the prostate are removed for closer study. Prostate cancer screening options include the digital rectal exam and the prostate specific antigen (PSA) blood test. Screening for prostate cancer is controversial because it is not clear if the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments. Prostate cancer screening is an attempt to identify individuals with prostate cancer in a broad segment of the population—those for whom there is no reason to suspect prostate cancer. ... Screening, in medicine, is a strategy used to identify disease in an unsuspecting population. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... A rectal examination or rectal exam is an internal examination of the rectum by a physician or other healthcare professional. ... Prostate specific antigen (PSA) is a protein produced by the cells of the prostate gland. ...


Prostate cancer is usually a slow-growing cancer, very common among older men. In fact, most prostate cancers never grow to the point where they cause symptoms, and most men with prostate cancer die of other causes before prostate cancer has an impact on their lives. The PSA screening test may detect these small cancers that would never become life threatening. Doing the PSA test in these men may lead to overdiagnosis, including additional testing and treatment. Follow-up tests, such as prostate biopsy, may cause pain, bleeding and infection. Prostate cancer treatments may cause urinary incontinence and erectile dysfunction. Therefore, it is essential that the risks and benefits of diagnostic procedures and treatment be carefully considered before PSA screening. Overdiagnosis is either (i) the diagnosis of asymptomatic disease or (ii) the false positive result of the application of diagnostic criteria that would not have given symptoms during the lifetime of a patient. ... Prostate biopsy is a procedure in which small samples are removed from a mans prostate gland to be tested for the presence of cancer. ... The tone or style of this article or section may not be appropriate for Wikipedia. ... Erectile dysfunction (ED) or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. ...


No major scientific or medical organizations currently support routine screening for prostate cancer.[46]

  • In 2002, the U.S. Preventive Services Task Force (USPSTF) concluded that the evidence was insufficient to recommend for or against routine screening for prostate cancer using PSA testing or digital rectal examination (DRE).[47] The previous 1995 USPSTF recommendation was against routine screening.
  • In 1997, American Cancer Society (ACS) guidelines began recommending that beginning at age 50 (age 45 for African-American men and men with a family history of prostate cancer, and since 2001, age 40 for men with a very strong family history of prostate cancer), PSA testing and DRE be offered annually to men who have a life-expectancy of 10 or more years (average life expectancy is 10 years or more for U.S. men under age 76)[48] along with information on the risks and benefits of screening.[49] The previous ACS recommendations since 1980 had been for routine screening for prostate cancer with DRE annually beginning at age 40, and since 1992 had been for routine screening with DRE and PSA testing annually beginning at age 50.[50]
  • The 2007 National Comprehensive Cancer Network (NCCN) guideline recommends offering a baseline PSA test and DRE at ages 40 and 45 and annual PSA testing and DRE beginning at age 50 (with annual PSA testing and DRE beginning at age 40 for African-American men, men with a family history of prostate cancer, and men with a PSA ≥ 0.6 ng/mL at age 40 or PSA > 0.6 ng/mL at age 45) through age 80, along with information on the risks and benefits of screening. Biopsy is recommended if DRE is positive or PSA ≥ 4 ng/mL, and biopsy considered if PSA > 2.5 ng/mL or PSA velocity ≥ 0.35 ng/mL/year when PSA ≤ 2.5 ng/mL.[51]
  • Some U.S. radiation oncologists and medical oncologists who specialize in treating prostate cancer recommend obtaining a baseline PSA in all men at age 35[52] or beginning annual PSA testing in high risk men at age 35.[53]

Since there is no firm evidence or general agreement that the benefits of PSA screening outweigh the harms, major scientific and medical organizations recommend that clinicians use a process of shared decision-making that includes discussing with patients the risks of prostate cancer, the potential benefits and harms of screening, and involving the patients in the decision.[54] According to the Agency for Healthcare Research Quality, US Preventive Services Task Force is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. ... The American Cancer Society (ACS) is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy and service. ... National Comprehensive Cancer Network is an alliance of twenty-one cancer centers from across the United States. ...


However, because PSA screening is widespread in the United States, following the recommendations of major scientific and medical organizations to use shared decision-making is legally perilous in some U.S. states.[55] In 2003, a Virginia jury found a family practice residency program guilty of malpractice and liable for $1 million for following national guidelines and using shared decision-making, thereby allowing a patient (subsequently found to have a high PSA and incurable advanced prostate cancer) to decline a screening PSA test, instead of routinely ordering without discussion PSA tests in all men ≥ 50 years of age as four local physicians testified was their practice, and was accepted by the jury as the local standard of care.[56] Federal courts Supreme Court Circuit Courts of Appeal District Courts Elections Presidential elections Midterm elections Political Parties Democratic Republican Third parties State & Local government Governors Legislatures (List) State Courts Local Government Other countries Atlas  US Government Portal      A U.S. state is any one of the fifty subnational entities of... This article is about the U.S. state. ... An empty jury box in an American courtroom For jury meaning makeshift, see jury rig. ... A general practitioner (GP), family physician or family practitioner (FP) is a medical doctor who provides primary care. ... Residency is a stage of postgraduate medical training in North America and leads to eligibility for board certification in a primary care or referral specialty. ... Medical malpractice is an act or omission by a health care provider which deviates from accepted standards of practice in the medical community and which causes injury to the patient. ... In tort law, the standard of care is the degree of prudence and caution required of an individual who is under a duty of care. ...


An estimated 20 million PSA tests are done per year in North America and possibly 20 million more outside of North America.[57]

  • In 2000, 34.1% of all U.S. men age ≥ 50 had a screening PSA test within the past year and 56.8% reported ever having a PSA test.[54]
  • In 2000, 33.6% of all U.S. men age 50–64 and 51.3% of men age ≥ 65 had a PSA test within the past year.[58]
  • In 2005, 33.5% of all U.S. men age 50–64 had a PSA test in the past year.
    • 37.5% of men with private health insurance, 20.8% of men with Medicaid insurance, 14.0% of currently uninsured men, and 11.5% of men uninsured for > 12 months.[59]
  • In 2000–2001, 34.1% of all Canadian men age ≥ 50 had a screening PSA test within the past year and 47.5% reported ever having a screening PSA test.[60]
  • Canadian men in Ontario were most likely to have had a PSA test within the past year and men in Alberta were least likely to have had a PSA test with the past year or ever.[61]

The term health insurance is generally used to describe a form of insurance that pays for medical expenses. ... Medicaid is the US health insurance program for individuals and families with low incomes and resources. ... Health care in the United States is provided by many separate legal entities. ... This article is about the Canadian province. ... For other uses, see Alberta (disambiguation). ...

Digital rectal examination

Digital rectal examination (DRE) is a procedure where the examiner inserts a gloved, lubricated finger into the rectum to check the size, shape, and texture of the prostate. Areas which are irregular, hard or lumpy need further evaluation, since they may contain cancer. Although the DRE only evaluates the back of the prostate, 85% of prostate cancers arise in this part of the prostate. Prostate cancer which can be felt on DRE is generally more advanced.[62] The use of DRE has never been shown to prevent prostate cancer deaths when used as the only screening test.[63] A rectal examination or rectal exam is an internal examination of the rectum by a physician or other healthcare professional. ...


Prostate specific antigen

The PSA test measures the blood level of prostate-specific antigen, an enzyme produced by the prostate. Specifically, PSA is a serine protease similar to kallikrein. Its normal function is to liquify gelatinous semen after ejaculation, allowing spermatozoa to more easily navigate through the uterine cervix. Prostate specific antigen (PSA) is a protein produced by the cells of the prostate gland. ... Prostate specific antigen (PSA) is a protein manufactured exclusively by the prostate gland; PSA is produced for the ejaculate where it liquifies the semen and allows sperm to swim freely. ... Ribbon diagram of the enzyme TIM, surrounded by the space-filling model of the protein. ... Crystal structure of Trypsin, a typical serine protease. ... Kallikrien (KLK) enzymes are a group of serine proteases found in many different tissues and body fluids. ... A spermatozoon or spermatozoan ( spermatozoa), from the ancient Greek σπέρμα (seed) and (living being) and more commonly known as a sperm cell, is the haploid cell that is the male gamete. ... The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ...


The risk of prostate cancer increases with increasing PSA levels.[64] 4 ng/mL was chosen arbitrarily as a decision level for biopsies in the clinical trial upon which the FDA in 1994 based adding prostate cancer detection in men age 50 and over as an approved indication for the first commercially available PSA test.[65] 4 ng/mL was used as the biopsy decision level in the PLCO trial, 3 ng/mL was used in the ERSPC and ProtecT trials, and 2.5 ng/mL is used in the 2007 NCCN guideline. “FDA” redirects here. ... Prostate cancer screening is an attempt to identify individuals with prostate cancer in a broad segment of the population—those for whom there is no reason to suspect prostate cancer. ... Prostate cancer screening is an attempt to identify individuals with prostate cancer in a broad segment of the population—those for whom there is no reason to suspect prostate cancer. ... Prostate cancer screening is an attempt to identify individuals with prostate cancer in a broad segment of the population—those for whom there is no reason to suspect prostate cancer. ...


PSA levels can change for many reasons other than cancer. Two common causes of high PSA levels are enlargement of the prostate (benign prostatic hypertrophy (BPH)) and infection in the prostate (prostatitis). It can also be raised for 24 hours after ejaculation and several days after catheterization. PSA levels are lowered in men who use medications used to treat BPH or baldness. These medications, finasteride (marketed as Proscar or Propecia) and dutasteride (marketed as Avodart), may decrease the PSA levels by 50% or more. Benign prostatic hyperplasia (BPH) is the increase in size of the prostate in middle_aged and elderly men. ... Prostatitis is any form of inflammation of the prostate gland. ... Bald redirects here; for other uses see Bald (disambiguation). ... Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is an antiandrogen which acts by inhibiting type II 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT). ... Dutasteride inhibits the conversion of testosterone into dihydrotestosterone. ...


Several other ways of evaluating the PSA have been developed to avoid the shortcomings of simple PSA screening. The use of age-specific reference ranges improves the sensitivity and specificity of the test. The rate of rise of the PSA over time, called the PSA velocity, has been used to evaluate men with PSA levels between 4 and 10 ng/ml, but it has not proven to be an effective screening test.[66] Comparing the PSA level with the size of the prostate, as measured by ultrasound or magnetic resonance imaging, has also been studied. This comparison, called PSA density, is both costly and has not proven to be an effective screening test.[67] PSA in the blood may either be free or bound to other proteins. Measuring the amount of PSA which is free or bound may provide additional screening information, but questions regarding the usefulness of these measurements limit their widespread use.[68][69] Sonography redirects here. ... MRI redirects here. ... A representation of the 3D structure of myoglobin showing coloured alpha helices. ...


Diagnosis

Normal prostate (A) and prostate cancer (B). In prostate cancer, the regular glands of the normal prostate are replaced by irregular glands and clumps of cells, as seen in these pictures taken through a microscope.

When a man has symptoms of prostate cancer, or a screening test indicates an increased risk for cancer, more invasive evaluation is offered. Image File history File linksMetadata Download high resolution version (1200x874, 322 KB) Summary Created by me based on photomicrographs from US government site http://cgap-mf. ... Image File history File linksMetadata Download high resolution version (1200x874, 322 KB) Summary Created by me based on photomicrographs from US government site http://cgap-mf. ...


The only test which 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, several other tools may be used to gather more information about the prostate and the urinary tract. 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. Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... A sterile flexible cystoscope in an operating theatre Hello this is a Message to Dad Quit Reading this stuff :) . Endoscopy of the urinary bladder via the urethra is called cystoscopy. ... In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ... Transrectal ultrasound A probe inserted in the rectum emits sound waves in order to image the prostate Transrectal ultrasound uses inaudible sound waves produced by a probe inserted into the rectum to create an image of organs in the pelvis. ...


Biopsy

Main article: Prostate biopsy

If cancer is suspected, a biopsy is offered. During a biopsy a urologist 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.[70] Prostate biopsy is a procedure in which small samples are removed from a mans prostate gland to be tested for the presence of cancer. ... This article or section is in need of attention from an expert on the subject. ...


Gleason score

Main article: 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. Gleason score Lower scores are associated with small, closely packed glands. ... Gleason score Lower scores are associated with small, closely packed glands. ...


Tumor markers

Main article: Tumor markers

Tissue samples can be stained for the presence of PSA and other tumor markers in order to determine the origin of maligant cells that have metastasized.[71] Tumor markers are substances found in the blood, urine or body tissues that can be elevated in cancer. ...


New tests being investigated

Currently, an active area of research involves non-invasive methods of prostate tumor detection. Adenoviruses modified to transfect tumor cells with harmless yet distinct genes (such as luciferase) have proven capable of early detection. So far, though, this area of research has only been tested in animal and LNCaP models.[72] This article needs to be cleaned up to conform to a higher standard of quality. ...


PCA3

Another potential non-invasive methods of early prostate tumor detection is through a molecular test that detects the presence of cell-associated PCA3 mRNA in urine. PCA3 mRNA is expressed almost exclusively by prostate cells and has been shown to be highly over-expressed in prostate cancer cells. PCA3 is not a replacement for PSA but an additional tool to help decide if, in men suspected of having prostate cancer, a biopsy is really needed. The higher the expression of PCA3 in urine, the greater the likelihood of a positive biopsy, i.e. the presence of cancer cells in the prostate. Company Diagnocure has an exclusive worldwide license for all diagnostic and therapeutic applications related to PCA3


Early prostate cancer

It was reported in April 2007 that a new blood test for early prostate cancer antigen-2 (EPCA-2) is being researched that may alert men if they have prostate cancer and how aggressive it will be.[73][74] Early prostate cancer antigen-2 (EPCA-2) is a protein of which blood levels are elevated in prostate cancer. ...


Staging

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. Prostate cancer staging is the process by which physicians evaluate the spread of prostate cancer. ... The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. ... Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... TNM Classification of Malignant Tumours (TNM) is the system developed and maintained by the International Union Against Cancer (UICC) to maintain consensus on one globally recognised standard for categorising cancer. ... Lymph nodes are components of the lymphatic system. ... For the musical composition, see Metastasis (Xenakis composition). ...


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 metastisis - opposite to what is found in many other cancers that metastasize. negron305 Cat scan redirects here. ... Drawing shows patient lying on a table that slides under the scanner, a technician operating the scanner, and a monitor that will show images made during the scan. ... Endorectal coil magnetic resonance imaging or endorectal coil MRI is a type of medical imaging in which MRI is used in conjunction with a coil placed into the rectum in order to obtain high quality images of the area surrounding the rectum. ... Categories: Stub | Andrology | Exocrine system | Reproductive system ...


Computed tomography (CT) and magnetic resonance imaging (MRI) currently do not add any significant information in the assessment of possible lymph node metastases in patients with prostate cancer according to a meta-analysis. [75] The sensitivity of CT was 42% and specificity of CT was 82%. The sensitivity of MRI was 39% and the specificity of MRI was 82%. For patients at similar risk to those in this study (17% had positive pelvic lymph nodes in the CT studies and 30% had positive pelvic lymph nodes in the MRI studies), this leads to a positive predictive value (PPV) of 32.3% with CT, 48.1% with MRI, and negative predictive value (NPV) of 87.3% with CT, 75.8% with MRI. negron305 Cat scan redirects here. ... MRI redirects here. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... The positive predictive value is the proportion of patients with positive test results who are correctly diagnosed. ... Binary classification is the task of classifying the members of a given set of objects into two groups on the basis of whether they have some property or not. ...


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. Proper grading of the tumor is critical, since the grade of the tumor is one of the major factors used to determine the treatment recommendation. A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... In pathology, Grading is a measure of the progress of tumors. ... Gleason score Lower scores are associated with small, closely packed glands. ... Prostate cancer staging is the process by which physicians evaluate the spread of prostate cancer. ...


Risk assessment

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 to 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 3 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 using 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.


Treatment

Treatment for prostate cancer may involve watchful waiting, surgery, radiation therapy (including brachytherapy, High Intensity Focused Ultrasound (HIFU), chemotherapy, cryosurgery, hormonal therapy, or some combination. Which option is best depends on the stage of the disease, the Gleason score, and the PSA level. Other important factors are the man's age, his general health, and his feelings 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. Watchful waiting, also referred to as observation, is an approach to a medical problem in which time is allowed to pass before further testing or therapy is pursued. ... “Surgeon” redirects here. ... Varian Clinac 2100C Linear Accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Brachytherapy for prostate cancer is administered using seeds, small radioactive rods implanted directly into the tumour. ... It has been suggested that Hifu be merged into this article or section. ... Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. ... Cryosurgery (cryotherapy) is the application of extreme cold to destroy abnormal or diseased tissue. ... Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ...


The selection of treatment options may be a complex decision involving many factors. For example, radical prostatectomy after primary radiation failure is a very technically challenging surgery and may not be an option.[76] This may enter into the treatment decision.


If the cancer has spread beyond the prostate, treatment options significantly change, so most doctors who treat prostate cancer use a variety of nomograms to predict the probability of spread. Treatment by watchful waiting, HIFU, radiation therapy, cryosurgery, and surgery are generally offered to men whose cancer remains within the prostate. Hormonal therapy and chemotherapy are often reserved for disease which 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, hormonal therapy, and chemotherapy may also be offered if initial treatment fails and the cancer progresses. Smith chart which shows how the complex impedance of a transmission line varies along its length This article is about the graphical devices called nomograms. ... Cryotherapy is used to define several techniques and procedures in the medical community. ...


Watchful waiting and active surveillance

Watchful waiting, also called "active surveillance," refers to observation and regular monitoring without invasive treatment. Watchful waiting is often used when an early stage, slow-growing prostate cancer is found in an older man. Watchful waiting may also be suggested when the risks of surgery, radiation therapy, or hormonal therapy outweigh the possible benefits. Other treatments can be started if symptoms develop, or if there are signs that the cancer growth is accelerating (e.g., rapidly rising PSA, increase in Gleason score on repeat biopsy, etc.). Most men who choose watchful waiting for early stage tumors eventually have signs of tumor progression, and they may need to begin treatment within three years.[77] Although men who choose watchful waiting avoid the risks of surgery and radiation, the risk of metastasis (spread of the cancer) may be increased. For younger men, a trial of active surveillance may not mean avoiding treatment altogether, but may reasonably allow a delay of a few years or more, during which time the quality of life impact of active treatment can be avoided. Published data to date suggest that carefully selected men will not miss a window for cure with this approach. Additional health problems that develop with advancing age during the observation period can also make it harder to undergo surgery and radiation therapy. Watchful waiting, also referred to as observation, is an approach to a medical problem in which time is allowed to pass before further testing or therapy is pursued. ...


Clinically insignificant prostate tumors are often found by accident when a doctor incorrectly orders a biopsy not following the recommended guidelines (abnormal DRE and elevated PSA). The urologist must check that the PSA is not elevated for other reasons, Prostatitis, etc. An annual biopsy is often recommended by a urologist for a patient who has selected watchful waiting when the tumor is clinically insignificant (no abnormal DRE or PSA). The tumors tiny size can be monitored this way and the patient can decide to have surgery only if the tumor enlarges which may take many years or never.


Surgery

Surgical removal of the prostate, or prostatectomy, is a common treatment either for early stage prostate cancer, or for cancer which has failed to respond to radiation therapy. The most common type is radical retropubic prostatectomy, when the surgeon removes the prostate through an abdominal incision. Another type is radical perineal prostatectomy, when the surgeon removes the prostate through an incision in the perineum, the skin between the scrotum and anus. Radical prostatectomy can also be performed laparoscopically, through a series of small (1cm) incisions in the abdomen, with or without the assistance of a surgical robot. A Prostatectomy is the surgical removal of all or part of the prostate gland. ... Radical retropubic prostatectomy is a surgical procedure in which the prostate gland is removed through an incision in the abdomen. ... Radical perineal prostatectomy is a surgical procedure wherein the prostate gland is removed through an incision in the area between the anus and the scrotum (perineum). ... In human anatomy, the perineum, also called the taint, or gooch, is generally defined as the surface region in both males and females between the pubic symphysis and the coccyx. ... In some male mammals the scrotum is a protuberance of skin and muscle containing the testicles. ... This article is about the bodily orifice. ...


Radical prostatectomy is effective for tumors which have not spread beyond the prostate;[78] cure rates depend on risk factors such as PSA level and Gleason grade. However, it may cause nerve damage that significantly alters the quality of life of the prostate cancer survivor. The most common serious complications are loss of urinary control and impotence. Reported rates of both complications vary widely depending on how they are assessed, by whom, and how long after surgery, as well as the setting (e.g., academic series vs. community-based or population-based data). Although penile sensation and the ability to achieve orgasm usually remain intact, erection and ejaculation are often impaired. Medications such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) may restore some degree of potency. For most men with organ-confined disease, a more limited "nerve-sparing" technique may help avoid urinary incontinence and impotence.[79] Radical prostatectomy is surgical removal of the entire prostate gland, the seminal vesicles and nearby tissue. ... For other uses, see Nerve (disambiguation). ... The tone or style of this article or section may not be appropriate for Wikipedia. ... Impotence or, more clinically, erectile dysfunction is the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ... An orgasm (sexual climax) is the conclusion of the plateau phase of the sexual response cycle, and may be experienced by both males and females. ... Sildenafil citrate, sold under the names Viagra, Revatio and generically under various other names, is a drug used to treat male erectile dysfunction (impotence) and pulmonary arterial hypertension (PAH), developed by the pharmaceutical company Pfizer. ... Tadalafil is an orally administered drug used to treat male erectile dysfunction (impotence). ... Vardenafil (INN) is a PDE5 inhibitor used in the treatment of erectile dysfunction. ...


Radical prostatectomy has traditionally been used alone when the cancer is small. In the event of positive margins or locally advanced disease found on pathology, adjuvant radiation therapy may offer improved survival. Surgery may also be offered when a cancer is not responding to radiation therapy. However, because radiation therapy causes tissue changes, prostatectomy after radiation has a higher risk of complications.


Laparoscopic radical prostatectomy, LRP, is the more modern form of the historical open radical retropubic prostatectomy. Contrasted with the open surgical form of prostate cancer surgery, laparoscopic radical prostatectomy does not require a large incision. Relying on modern technology, such as miniaturization, fiber optics, and the like, laparoscopic radical prostatectomy is a minimally invasive prostate cancer treatment and a departure from what historically required the application of relatively primitive surgical techniques. Laparoscopic radical prostatectomy is not a new prostate cancer treatment. Rather, laparoscopic radical prostatectomy is a modern means of performing prostate cancer surgery, the oldest treatment for prostate cancer.


The LRP technical manual was published in 1999 by Drs. Bertrand Guillonneau, Arnon Krongrad, and Guy Vallancien. LRP is laparoscopic prostate surgery, not laser prostate surgery.


In the hands of an experienced surgeon, robotic assisted laparoscopic prostatectomy (RALP) may reduce positive surgical margins when compared to radical retropubic prostatectomy (RRP) among patients with prostate cancer according to a retrospective study. [75] The relative risk reduction was 57.7%. For patients at similar risk to those in this study (35.5% of patients had positive surgical margins following RRP), this leads to an absolute risk reduction of 20.5%. 4.9 patients must be treated for one to benefit (number needed to treat = 4.9). Radical retropubic prostatectomy is a surgical procedure in which the prostate gland is removed through an incision in the abdomen. ... The relative risk reduction is a measure used in epidemiology. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ...


Transurethral resection of the prostate, commonly called a "TURP," is a surgical procedure performed when the tube from the bladder to the penis (urethra) is blocked by prostate enlargement. TURP is generally for benign disease and is not meant as definitive treatment for prostate cancer. During a TURP, a small tube (cystoscope) is placed into the penis and the blocking prostate is cut away. Transurethral resection of prostate (TURP) is a urological operation. ... In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ... Endoscopy of the urinary bladder via the urethra is called cystoscopy. ...


In metastatic disease, where cancer has spread beyond the prostate, removal of the testicles (called orchiectomy) may be done to decrease testosterone levels and control cancer growth. (See hormonal therapy, below). Look up testes in Wiktionary, the free dictionary. ... Orchiectomy is the surgical removal of one or both testicles. ...


Radiation therapy

Brachytherapy for prostate cancer is administered using "seeds," small radioactive rods implanted directly into the tumor.

Radiation therapy, also known as radiotherapy, is often used to treat all stages of prostate cancer, or when surgery fails. Radiotherapy uses ionizing radiation to kill prostate cancer cells. When absorbed in tissue, Ionizing radiation such as Gamma and x-rays damage the DNA in cells, which increases the probability of apoptosis (cell death). Two different kinds of radiation therapy are used in prostate cancer treatment: external beam radiation therapy and brachytherapy. Image File history File linksMetadata Brachytherapy. ... Image File history File linksMetadata Brachytherapy. ... Brachytherapy for prostate cancer is administered using seeds, small radioactive rods implanted directly into the tumour. ... Varian Clinac 2100C Linear Accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Radiation hazard symbol. ... Radiation hazard symbol. ... The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ... External beam radiotherapy otherwise known as teletherapy, is the most frequently used form of radiotherapy. ... Brachytherapy for prostate cancer is administered using seeds, small radioactive rods implanted directly into the tumour. ...


External beam radiation therapy uses a linear accelerator to produce high-energy x-rays which are directed in a beam towards the prostate. A technique called Intensity Modulated Radiation Therapy (IMRT) may be used to adjust the radiation beam to conform with the shape of the tumor, allowing higher doses to be given to the prostate and seminal vesicles with less damage to the bladder and rectum. External beam radiation therapy is generally given over several weeks, with daily visits to a radiation therapy center. New types of radiation therapy may have fewer side effects then traditional treatment, one of these is Tomotherapy. A Linear particle accelerator is an electrical device for the acceleration of subatomic particles. ... Clinac 2100 C accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... TomoTherapy is a radiation therapy delivery system. ...

External beam radiation therapy for prostate cancer is delivered by a linear accelerator, such as this one.

Permanent implant brachytherapy is a popular treatment choice for patients with low to intermediate risk features, can be performed on an outpatient basis, and is associated with good 10-year outcomes with relatively low morbidity[80] It involves the placement of about 100 small "seeds" containing radioactive material (such as iodine-125 or palladium-103) with a needle through the skin of the perineum directly into the tumor while under spinal or general anesthetic. These seeds emit lower-energy X-rays which are only able to travel a short distance. Although the seeds eventually become inert, they remain in the prostate permanently. The risk of exposure to others from men with implanted seeds is generally accepted to be insignificant.[81] Image File history File links Linacprostate. ... Image File history File links Linacprostate. ... External beam radiotherapy otherwise known as teletherapy, is the most frequently used form of radiotherapy. ... Iodine-125 is a radioisotope of iodine which has uses in biological assays and in radiation therapy to treat prostate cancer and brain tumors. ... Palladium-103 is a radioisotope of the element palladium which has uses in radiation therapy for prostate cancer and ocular melanoma. ... In human anatomy, the perineum, also called the taint, or gooch, is generally defined as the surface region in both males and females between the pubic symphysis and the coccyx. ... Superficial X-rays do not penetrate very far before they are absorbed. ...


Radiation therapy is commonly used in prostate cancer treatment. It may be used instead of surgery or after surgery in early stage prostate cancer. In advanced stages of prostate cancer radiation is used to treat painful bone metastases. Radiation treatments also can be combined with hormonal therapy for intermediate risk disease, when radiation therapy alone is less likely to cure the cancer. Some radiation oncologists combine external beam radiation and brachytherapy for intermediate to high risk situations. One study found that the combination of six months of androgen suppressive therapy combined with external beam radiation had improved survival compared to radiation alone in patients with localized prostate cancer.[82] Others use a "triple modality" combination of external beam radiation therapy, brachytherapy, and hormonal therapy.


Less common applications for radiotherapy are when cancer is compressing the spinal cord, or sometimes after surgery, such as when cancer is found in the seminal vesicles, in the lymph nodes, outside the prostate capsule, or at the margins of the biopsy.


Radiation therapy is often offered to men whose medical problems make surgery more risky. Radiation therapy appears to cure small tumors that are confined to the prostate just about as well as surgery. However, some issues remain unresolved, such as whether radiation should be given to the rest of the pelvis, how much the absorbed dose should be, and whether hormonal therapy should be given at the same time. Absorbed dose is a measure of the energy deposited in a medium by ionising radiation. ...


Side effects of radiation therapy might occur after a few weeks into treatment. Both types of radiation therapy may cause diarrhea and rectal bleeding due to radiation proctitis, as well as urinary incontinence and impotence. Symptoms tend to improve over time.[83] Men who have undergone external beam radiation therapy will have a higher risk of later developing colon cancer and bladder cancer.[84] Diarrhea, also spelled diarrhoea (see spelling differences), is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause of death in developing countries (particularly among infants), accounting for 5 to 8 million deaths... Gastrointestinal bleeding describes every form of hemorrhage (blood loss) in the gastrointestinal tract, from the pharynx to the rectum. ... Radiation proctitis (and the related radiation colitis) is inflammation and damage to the lower parts of the colon after exposure to x-rays or other ionizing radiation as a part of radiation therapy. ... Diagram of the stomach, colon, and rectum Colorectal cancer includes cancerous growths in the colon, rectum and appendix. ... Bladder cancer refers to any of several types of malignant growths of the urinary bladder. ...


Cryosurgery

Cryosurgery is another method of treating prostate cancer. It is less invasive than radical prostatectomy, and general anesthesia is less commonly used. Under ultrasound guidance, a method invented by Dr. Gary Onik,[85] metal rods are inserted through the skin of the perineum into the prostate. Highly purified Argon gas is used to cool the rods, freezing the surrounding tissue at −196 °C (−320 °F). As the water within the prostate cells freeze, the cells die. The urethra is protected from freezing by a catheter filled with warm liquid. Cryosurgery generally causes fewer problems with urinary control than other treatments, but impotence occurs up to ninety percent of the time. When used as the initial treatment for prostate cancer and in the hands of an experienced cryosurgeon, cryosurgery has a 10 year biochemical disease free rate superior to all other treatments including radical prostatectomy and any form of radiation[86] Cryosurgery has also been demonstrated to be superior to radical prostatectomy for recurrent cancer following radiation therapy. Cryosurgery (cryotherapy) is the application of extreme cold to destroy abnormal or diseased tissue. ... This article or section may be confusing for some readers, and should be edited to be clearer. ... There are very few or no other articles that link to this one. ... In human anatomy, the perineum, also called the taint, or gooch, is generally defined as the surface region in both males and females between the pubic symphysis and the coccyx. ... For other uses, see Celsius (disambiguation). ... For other uses, see Fahrenheit (disambiguation). ... In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ... Diagram of a foley catheter Foley catheters are flexible (usually latex) tubes that are passed through the urethra during urinary catheterization and into the bladder to drain urine. ...


Hormonal therapy

Hormonal therapy in prostate cancer. Diagram shows the different organs (purple text), hormones (black text and arrows), and treatments (red text and arrows) important in hormonal therapy.

Hormonal therapy uses medications or surgery to block prostate cancer cells from getting dihydrotestosterone (DHT), a hormone produced in the prostate and required for the growth and spread of most prostate cancer cells. Blocking DHT often causes prostate cancer to stop growing and even shrink. However, hormonal therapy rarely cures prostate cancer because cancers which initially respond to hormonal therapy typically become resistant after one to two years. Hormonal therapy is therefore usually used when cancer has spread from the prostate. It may also be given to certain men undergoing radiation therapy or surgery to help prevent return of their cancer.[87] Image File history File linksMetadata Download high resolution version (600x1600, 360 KB) Summary Created by me, all rights released Licensing I, the creator of this work, hereby release it into the public domain. ... Image File history File linksMetadata Download high resolution version (600x1600, 360 KB) Summary Created by me, all rights released Licensing I, the creator of this work, hereby release it into the public domain. ... Hormonal therapy is one of the major modalities of medical treatment for cancer, others being cytotoxic chemotherapy and targeted therapy (biotherapeutics). ... For other uses, see DHT (disambiguation). ...


Hormonal therapy for prostate cancer targets the pathways the body uses to produce DHT. A feedback loop involving the testicles, the hypothalamus, and the pituitary, adrenal, and prostate glands controls the blood levels of DHT. First, low blood levels of DHT stimulate the hypothalamus to produce gonadotropin releasing hormone (GnRH). GnRH then stimulates the pituitary gland to produce luteinizing hormone (LH), and LH stimulates the testicles to produce testosterone. Finally, testosterone from the testicles and dehydroepiandrosterone from the adrenal glands stimulate the prostate to produce more DHT. Hormonal therapy can decrease levels of DHT by interrupting this pathway at any point. In cybernetics and control theory, feedback is a process whereby some proportion or in general, function, of the output signal of a system is passed (fed back) to the input. ... The hypothalamus links the nervous system to the endocrine system via the pituitary gland (hypophysis). ... Gonadotropin Releasing Hormone (GnRH) is a peptide hormone responsible for the release of FSH and LH from the anterior pituitary. ... | Latin = hypophysis, glandula pituitaria | GraySubject = 275 | GrayPage = 1275 | Image = Gray1180. ... Luteinizing hormone (LH) is a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland. ... Human male anatomy The testicles, known medically as testes (singular testis), are the male generative glands in animals. ... In mammals, the adrenal glands (also known as suprarenal glands) are the triangle-shaped endocrine glands that sit on top of the kidneys; their name indicates that position (ad-, near or at + -renes, kidneys). They are chiefly responsible for regulating the stress response through the synthesis of corticosteroids and catecholamines...


There are several forms of hormonal therapy:

  • Orchiectomy is surgery to remove the testicles. Because the testicles make most of the body's testosterone, after orchiectomy testosterone levels drop. Now the prostate not only lacks the testosterone stimulus to produce DHT, but also it does not have enough testosterone to transform into DHT.
  • Antiandrogens are medications such as flutamide, bicalutamide, nilutamide, and cyproterone acetate which directly block the actions of testosterone and DHT within prostate cancer cells.
  • Medications which block the production of adrenal androgens such as DHEA include ketoconazole and aminoglutethimide. Because the adrenal glands only make about 5% of the body's androgens, these medications are generally used only in combination with other methods that can block the 95% of androgens made by the testicles. These combined methods are called total androgen blockade (TAB). TAB can also be achieved using antiandrogens.
  • GnRH action can be interrupted in one of two ways. GnRH antagonists suppress the production of LH directly, while GnRH agonists suppress LH through the process of downregulation after an initial stimulation effect. Abarelix is an example of a GnRH antagonist, while the GnRH agonists include leuprolide, goserelin, triptorelin, and buserelin. Initially, GnRH agonists increase the production of LH. However, because the constant supply of the medication does not match the body's natural production rhythm, production of both LH and GnRH decreases after a few weeks.[88]

The most successful hormonal treatments are orchiectomy and GnRH agonists. Despite their higher cost, GnRH agonists are often chosen over orchiectomy for cosmetic and emotional reasons. Eventually, total androgen blockade may prove to be better than orchiectomy or GnRH agonists used alone. Castration (also referred as: gelding, neutering, orchiectomy, orchidectomy, and oophorectomy) is any action, surgical, chemical, or otherwise, by which a male loses the functions of the testes or a female loses the functions of the ovaries. ... An antiandrogen, or androgen antagonist, is any of a group of hormone antagonist compounds that are capable of preventing or inhibiting the biologic effects of androgens, male sex hormones, on normally responsive tissues in the body (see androgen insensitivity syndrome). ... Flutamide is an oral antiandrogen drug primarily used to treat prostate cancer. ... Bicalutamide is an oral non-steroidal anti-androgen for prostate cancer. ... Nilutamide is an antiandrogen medication used in the treatment of advanced stage prostate cancer. ... Cyproterone acetate (Androcur®, Cyprostat®) is an antiandrogen, i. ... Ketoconazole is a synthetic antifungal drug used to prevent and treat skin and fungal infections, especially in immunocompromised patients such as those with AIDS. Due to its side-effect profile, it has been superseded by newer antifungals, such as fluconazole and itraconazole. ... Aminoglutethimide is an aromatase inhibitor used in the treatment of breast cancer which blocks the synthesis of estrogen. ... A gonadotropin-releasing hormone analog, also known as a GnRH analog, is a class of synthetic peptide drugs modeled on the human hypothalamic gonadotropin-releasing hormone (GnRH) and designed to mimic or antagonize the physiological effects of GnRH for therapeutic purposes. ... A gonadotropin-releasing hormone analog, also known as a GnRH analog, is a class of synthetic peptide drugs modeled on the human hypothalamic gonadotropin-releasing hormone (GnRH) and designed to mimic or antagonize the physiological effects of GnRH for therapeutic purposes. ... Down regulation is the process by which a cell decreases the number of receptors to a given hormone or neurotransmitter to reduce its sensitivity to this molecule. ... Abarelix also called plenaxis is a drug used to reduce the amount of testosterone made in patients with advanced symptomatic prostate cancer for which no other treatment options are available. ... Leuprolide is a gonadotropin releasing hormone agonist (GnRH agonist). ... Goserelin is an injectable luteinising hormone-releasing hormone analogue (LHRHa). ... Triptorelin (acetate or palmoate) is a gonadotropin releasing hormone agonist (GnRH agonist). ... Buserelin is a gonadotropin releasing hormone agonist (GnRH agonist). ...


Each treatment has disadvantages which limit its use in certain circumstances. Although orchiectomy is a low-risk surgery, the psychological impact of removing the testicles can be significant. The loss of testosterone also causes hot flashes, weight gain, loss of libido, enlargement of the breasts (gynecomastia), impotence and osteoporosis. GnRH agonists eventually cause the same side effects as orchiectomy but may cause worse symptoms at the beginning of treatment. When GnRH agonists are first used, testosterone surges can lead to increased bone pain from metastatic cancer, so antiandrogens or abarelix are often added to blunt these side effects. Estrogens are not commonly used because they increase the risk for cardiovascular disease and blood clots. The antiandrogens do not generally cause impotence and usually cause less loss of bone and muscle mass. Ketoconazole can cause liver damage with prolonged use, and aminoglutethimide can cause skin rashes. A hot flush (sometimes hot flash or night sweat) is a symptom of menopause and changing hormone levels which typically expresses itself at night as periods of intense heat with sweating and rapid heartbeat and may typically last from two to thirty minutes on each occasion. ... For other uses, see Libido (disambiguation). ... For other uses, see Breast (disambiguation). ... Gynecomastia, or gynaecomastia, pronounced is the development of abnormally large mammary glands in males resulting in breast enlargement, which can sometimes cause secretion of milk. ... Osteoporosis is a disease of bone - leading to an increased risk of fracture. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... Hepatotoxicity (from hepatic toxicity) implies chemical-driven liver damage. ... A rash is a change in skin which affects its color, appearance, or texture. ...


Palliative care

Palliative care for advanced stage prostate cancer focuses on extending life and relieving the symptoms of metastatic disease. Chemotherapy may be offered to slow disease progression and postpone symptoms. The most commonly used regimen combines the chemotherapeutic drug docetaxel with a corticosteroid such as prednisone.[89] Bisphosphonates such as zoledronic acid have been shown to delay skeletal complications such as fractures or the need for radiation therapy in patients with hormone-refractory metastatic prostate cancer.[90] Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than providing a cure. ... Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. ... Docetaxel chemical structure Docetaxel is a chemotherapy drug used in the treatment of cancer. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Prednisone is a synthetic corticosteroid drug which is usually taken orally but can be delivered by intramuscular injection and can be used for a great number of different conditions. ... In pharmacology, bisphosphonates (also called: diphosphonates) is a class of drugs that inhibits the resorption of bone. ... Zoledronate (Zometa®, Novartis) is a bisphosphonate, used to prevent osteoporosis and skeletal fractures, particularly in patients with cancers such as multiple myeloma and prostate cancer. ... For other uses, see Fracture (disambiguation). ...


Bone pain due to metastatic disease is treated with opioid pain relievers such as morphine and oxycodone. External beam radiation therapy directed at bone metastases may provide pain relief. Injections of certain radioisotopes, such as strontium-89, phosphorus-32, or samarium-153, also target bone metastases and may help relieve pain. Bone Pain- Bone pain is generally referred to as having pain within the affected bone. ... An opioid is a chemical substance that has a morphine-like action in the body. ... An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ... This article is about the drug. ... Not to be confused with oxytocin. ... Look up Pain in Wiktionary, the free dictionary. ... A radionuclide is an atom with an unstable nucleus. ... General Name, Symbol, Number Strontium, Sr, 38 Series Alkaline earth metal Group, Period, Block 2 (IIA), 5, s Density, Hardness 2630 kg/m3, 1. ... General Name, Symbol, Number phosphorus, P, 15 Chemical series Nonmetals Group, Period, Block 15 (VA), 3 , p Density, Hardness 1823 kg/m3, __ Appearance colorless/red/silvery white Atomic properties Atomic weight 30. ... Samarium-153-ethylene diamine tetramethylene phosphonate, Samarium-153 EDTMP, or simply Samarium-153 is a complex of a radioisotope of the lanthanide element Samarium with carrier EDTMP which is used to treat pain when cancer has spread to the bone. ...


High Intensity Focused Ultrasound (HIFU)

HIFU for prostate cancer utilizes high intensity focused ultrasound (HIFU) to ablate/destroy the tissue of the prostate. During the HIFU procedure, sound waves are used to heat the prostate tissue thus destroying the cancerous cells. Essentially, ultrasonic waves are precisely focused on specific areas of the prostate to eliminate the prostate cancer with minimal risks of affecting other tissue or organs. Temperatures at the focal point of the sound waves can exceed 100oC.[91] In lay terms, the HIFU technology is similar to using a magnifying glass to burn a piece of paper by focusing sunlight at a small precise point on the sheet. The ability to focus the ultrasonic waves leads to a relatively low occurrence of both incontinence and impotence. (0.6% and 0-20%, respectively)[92] According to international studies, when compared to other procedures, HIFU has a high success rate with a reduced risk of side effects. Studies using the Sonablate 500 HIFU machine have shown that 94% of patients with a pretreatment PSA (Prostate Specific Antigen) of less than 10 g/ml were cancer-free after three years.[93] However, many studies of HIFU were performed by manufacturers of HIFU devices, or members of manufacturers' advisory panels.[94] HIFU, or high intensity focused ultrasound, also referred to as Focused Ultrasound Surgery (FUS), is a term used describe a minimally or non-invasive method to deposit acoustic energy into tissue. ... // HIFU (high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused ultrasound to heat and destroy pathogenic tissue rapidly. ... HIFU, or high intensity focused ultrasound, also referred to as Focused Ultrasound Surgery (FUS), is a term used describe a minimally or non-invasive method to deposit acoustic energy into tissue. ... HIFU, or high intensity focused ultrasound, also referred to as Focused Ultrasound Surgery (FUS), is a term used describe a minimally or non-invasive method to deposit acoustic energy into tissue. ... Look up incontinence in Wiktionary, the free dictionary. ... Impotence or, more clinically, erectile dysfunction is the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ... HIFU, or high intensity focused ultrasound, also referred to as Focused Ultrasound Surgery (FUS), is a term used describe a minimally or non-invasive method to deposit acoustic energy into tissue. ... HIFU, or high intensity focused ultrasound, also referred to as Focused Ultrasound Surgery (FUS), is a term used describe a minimally or non-invasive method to deposit acoustic energy into tissue. ... Prostate specific antigen (PSA) is a protein produced by the cells of the prostate gland. ...



HIFU was first used in the 1940’s and 1950’s in efforts to destroy tumors in the central nervous system. Since then, HIFU has been shown to be effective at destroying malignant tissue in the brain, prostate, spleen, liver, kidney, breast, and bone.[95] Today, the HIFU procedure for prostate cancer is performed using a transrectal probe. This procedure has been performed for over ten years and is currently approved for use in Japan, Europe, Canada, and parts of Central and South America. HIFU, or high intensity focused ultrasound, also referred to as Focused Ultrasound Surgery (FUS), is a term used describe a minimally or non-invasive method to deposit acoustic energy into tissue. ... HIFU, or high intensity focused ultrasound, also referred to as Focused Ultrasound Surgery (FUS), is a term used describe a minimally or non-invasive method to deposit acoustic energy into tissue. ... HIFU, or high intensity focused ultrasound, also referred to as Focused Ultrasound Surgery (FUS), is a term used describe a minimally or non-invasive method to deposit acoustic energy into tissue. ...


Although not yet approved for use in the Unites States, many patients have received the HIFU procedure at facilities in Canada, and Central and South America. Currently, therapy is available using the Sonablate 500 or the Ablatherm. The Sonablate 500 is designed by Focus Surgery of Indianapolis, Indiana and is used in international HIFU centers around the world. HIFU, or high intensity focused ultrasound, also referred to as Focused Ultrasound Surgery (FUS), is a term used describe a minimally or non-invasive method to deposit acoustic energy into tissue. ...


Prognosis

Prostate cancer rates are higher and prognosis 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 and dairy products (although it must be noted, that people who consume larger amounts of meat and dairy, also tend to consume fewer portions of fruits and vegetables. It's not currently known whether or not both of this factors, or just one of them, contributes to the ocurrance of prostate cancer).[96] 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 United States men. Prostate cancer affected eighteen percent of American men and caused death in three percent in 2005.[97] In Japan, death from prostate cancer was one-fifth to one-half the rates in the United States and Europe in the 1990s.[98] In India in the 1990s, half of the people with prostate cancer confined to the prostate died within ten years.[99] African-American men have 50–60 times more prostate cancer and prostate cancer deaths than men in Shanghai, China.[100] In Nigeria, two percent of men develop prostate cancer and 64% of them are dead after two years.[101] A developed country is a country that has achieved (currently or historically) a high degree of industrialization, and which enjoys the higher standards of living which wealth and technology make possible. ... For other uses, see Europe (disambiguation). ... For other uses, see Shanghai (disambiguation). ...


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.[102] Smith chart which shows how the complex impedance of a transmission line varies along its length This article is about the graphical devices called nomograms. ...


Progression

In 1941, Charles Huggins reported that androgen ablation therapy causes regression of primary and metastatic androgen-dependent prostate cancer.[103] However, it is now known that 80–90% of prostate cancer patients develop androgen-independent tumors 12–33 months after androgen ablation therapy, leading to a median overall survival of 23–37 months from the time of initiation of androgen ablation therapy.[104] The actual mechanism contributes to the progression of prostate cancer is not clear and may vary between individual patient. A few possible mechanisms have be proposed.[105] Scientists have established a few prostate cancer cell lines to investigate the mechanism involved in the progression of prostate cancer. LNCaP, PC-3, and DU-145 are commonly used prostate cancer cell lines. The LNCaP cancer cell line was established from a human lymph node metastatic lesion of prostatic adenocarcinoma. PC-3 and DU-145 cells were established from human prostatic adenocarcinoma metastatic to bone and to brain, respectively. LNCaP cells express androgen receptor (AR), however, PC-3 and DU-145 cells express very little or no AR. AR, an androgen-activated transcription factor, belongs to the steroid nuclear receptor family. Development of the prostate is dependent on androgen signaling mediated through AR, and AR is also important during the development of prostate cancer. The proliferation of LNCaP cells is androgen-dependent but the proliferation of PC-3 and DU-145 cells is androgen-insensitive.Elevation of AR expression is often observed in advanced prostate tumors in patients.[106][107] Some androgen-independent LNCaP sublines have been developed from the ATCC androgen-dependent LNCaP cells after androgen deprivation for study of prostate cancer progression. These androgen-independent LNCaP cells have elevated AR expression and express prostate specific antigen upon androgen treatment. Androgens paradoxically inhibit the proliferation of these androgen-independent prostate cancer cells.[108][109][110] Androgen at a concentration of 10-fold higher than the physiological concentration has also been shown to cause growth suppression and reversion of androgen-independent prostate cancer xenografts or androgen-independent prostate tumors derived in vivo model to an androgen-stimulated phenotype in athymic mice.[111][112] These observation suggest the possibility to use androgen to treat the development of relapsed androgen-independent prostate tumors in patients. Oral infusion of green tea polyphenols, a potential alternative therapy for prostate cancer by natural compounds, has been shown to inhibit the development, progression, and metastasis as well in autochthonous transgenic adenocarcinoma of the mouse prostate (TRAMP) model, which spontaneously develops prostate cancer.[113] Dr. Charles Breton Huggins (September 22, 1901–January 12, 1997) was a Canadian-born American physician and physiologist and cancer researcher at the University of Chicago specialising in prostate cancer. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... The androgen receptor is an intracellular steroid receptor that specifically binds testosterone and dihydrotestosterone. ... In molecular biology, a transcription factor is a protein that binds DNA at a specific promoter or enhancer region or site, where it regulates transcription. ... Nuclear receptors are a class of intracellular receptors which function as ligand activated transcription factors which up or down regulate the expression of genes. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... For malignant tumors specifically, see cancer. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... AR, Ar or ar can mean: the letter R // Arabic language (ISO 639 alpha-2 language code) .ar, the ccTLD for Argentina Argentina, ISO 3166-1 alpha-2 and FIPS 10-4 digram country code Appenzell Outer Rhodes, Swiss canton Arkansas (United States postal abbreviations) Applied Relaxation, a form of... Prostate specific antigen (PSA) is a protein produced by the cells of the prostate gland. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... In vivo (Latin for (with)in the living). ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Green tea (绿茶) is tea that has undergone minimal oxidation during processing. ... Polyphenols are a group of vegetable chemical substances, characterized by the presence of more than one phenolic group. ... For the musical composition, see Metastasis (Xenakis composition). ...


History

Andrzej W. Schally was awarded the 1977 Nobel prize in Medicine for his research relating to prostate cancer.

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.[114] 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.[115] Removal of the entire gland (radical perineal prostatectomy) was first performed in 1904 by Hugh H. Young at Johns Hopkins Hospital.[116] 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.[117] This surgical approach allowed for removal of the prostate and lymph nodes with maintenance of penile function. Image File history File linksMetadata Schally_portrait. ... Image File history File linksMetadata Schally_portrait. ... Andrzej Wiktor Schally (born November 20, 1926) in Wilno, Poland), is a Polish endocrinologist and Nobel Prize winner in 1977 in Medicine for research work. ... For other uses, see Venice (disambiguation). ... Niccolò Massa (1485–1569) was an Italian anatomist who wrote an early anatomy text Anatomiae Libri Introductorius in 1536. ... For other uses, see Flanders (disambiguation). ... Andreas Vesalius (Brussels, December 31, 1514 - Zakynthos, October 15, 1564) was an anatomist, physician, and author of one of the most influential books on human anatomy, De humani corporis fabrica (On the Workings of the Human Body). ... This article is about the measure of remaining life. ... A Prostatectomy is the surgical removal of all or part of the prostate gland. ... Hugh Hampton Young, MD (18 September 1870–23 August 1945) was an American surgeon, urologist, and medical researcher. ... The Dome of the Johns Hopkins Hospital as seen from Broadway. ... Orchiectomy is the surgical removal of one or both testicles. ... Transurethral resection of prostate (TURP) is a urological operation. ...


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.[118] 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. Receptor agonists, such as leuprolide and goserelin, were subsequently developed and used to treat prostate cancer.[119][120] Dr. Charles Breton Huggins (September 22, 1901 – January 12, 1997) was a Canadian-born American physician and physiologist and cancer researcher at the University of Chicago specialising in prostate cancer. ... Estriol. ... Castration (also referred as: gelding, neutering, orchiectomy, orchidectomy, and oophorectomy) is any action, surgical, chemical, or otherwise, by which a male loses the functions of the testes or a female loses the functions of the ovaries. ... Emil Adolf von Behring was the first person to receive the Nobel Prize in Physiology or Medicine, for his work on the treatment of diphtheria. ... Gonadotropin Releasing Hormone (GnRH) is a peptide hormone responsible for the release of FSH and LH from the anterior pituitary. ... Andrzej Wiktor Schally (born November 20, 1926) in Wilno, Poland), is a Polish endocrinologist and Nobel Prize winner in 1977 in Medicine for research work. ... Roger Guillemin (born January 11, 1924 in Dijon, Bourgogne, France) received the National Medal of Science in 1976, and Nobel prize for medicine in 1977 for his work on neurohormones. ... Leuprolide is a gonadotropin releasing hormone agonist (GnRH agonist). ... Goserelin is an injectable luteinising hormone-releasing hormone analogue (LHRHa). ...


Radiation therapy for prostate cancer was first developed in the early 20th century and initially consisted of intraprostatic radium implants. External beam radiation became more popular as stronger radiation sources became available in the middle of the 20th century. Brachytherapy with implanted seeds was first described in 1983.[121] 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.[122] Varian Clinac 2100C Linear Accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... For other uses, see Radium (disambiguation). ... Cyclophosphamide (the generic name for Cytoxan, Neosar) is a nitrogen mustard alkylating agent, used to treat various types of cancer and some autoimmune disorders. ... Fluorouracil (5-FU) is a drug that is used in the treatment of cancer. ...


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See also

Testosterone is a steroid hormone from the androgen group. ...

External links

  • Prostate cancer at the Open Directory Project
  • Prostate Cancer Research Foundation of Canada
  • Malecare Prostate Cancer Support
  • Prostate Cancer Foundation
  • National Institute on Aging Information Center
  • National Prostate Cancer Coalition (NPCC)
  • OutWithCancer nonprofit Gay & Bisexaul focused Prostate Cancer Support
  • PROCURE: Prostate cancer. The healing begins with awareness.
  • Prostate Cancer Treatment Information
  • A massive aggregation of media articles and data collated by patients for patients & Forum for patients and carers
  • PCA3: Helping you decide when prostate biopsy is right

Thyroid cancer is cancer of the thyroid gland. ... Thyroid cancer is cancer of the thyroid gland. ... Adrenocortical carcinoma is a carcinoma of the cortex (outer layer) of the adrenal gland. ... A phaeochromocytoma (pheochromocytoma in the US) is a neuroendocrine tumor of the medulla of the adrenal glands originating in the chromaffin cells, which secretes excessive amounts of catecholamines, usually adrenaline and noradrenaline (epinephrine and norepinephrine in the US). ... Pituitary adenomas are tumors that occur in the pituitary gland, and account for about 10% of intracranial neoplasms. ... A tumor suppressor gene is a gene that reduces the probability that a cell in a multicellular organism will turn into a tumor cell. ... An oncogene is a modified gene that increases the malignancy of a tumor cell. ... The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. ... In pathology, Grading is a measure of the progress of tumors. ... Cancers are caused by a series of mutations. ... Look up carcinogen in Wiktionary, the free dictionary. ... Cancer research is research into cancer in order to identify causes and develop strategies for prevention, diagnosis, treatments and cure. ... A paraneoplastic phenomenon is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells. ... This is a list of terms related to oncology. ...


  Results from FactBites:
 
MedlinePlus Medical Encyclopedia: Prostate cancer (1750 words)
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 75 years old.
Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.
Removal of prostate gland (radical prostatectomy) is often recommended for treatment of stage A and B prostate cancers.
Prostate Cancer (550 words)
Prostate cancer is the second leading cause of cancer deaths in men, second to lung cancer.
Prostate cancer is often slow growing, usually occurs late in life, and often has no symptoms until the disease is well advanced.
Prostate cancer is an abnormal, uncontrolled growth of cells that results in the formation of a tumor in the prostate.
  More results at FactBites »

 
 

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