Prostrate cancer

Prostate cancer Service

Prostate cancer is a malignant tumor that arises in the prostate gland.

Risk Factors and Prevention

Men over age 40 and most often after age 50. Two-thirds of prostate cancers are found in men over age 65.

Men with a family history of the disease have a higher risk of developing prostate cancer. Having one family member with prostate cancer doubles a mans own risk, and having three family members increases risk by 11-fold.

African-American men have the worlds highest risk for prostate cancer. Men who live in Asia have lower risks for prostate cancer.

• Hormones
• Male hormones (androgens), particularly testosterone,
• The growth hormone insulin-like growth factor-1(IGF-1) may also be associated with some types of prostate cancer.
• Obesity. It may increase the risk for more aggressive forms of the disease.

• Fats. High consumption of red meat and high-fat dairy products has been linked to increased risk for prostate cancer.
• Vegetables and Fruits. Protect against prostate cancer.

Many studies indicate that vitamin D may help protect against prostate cancer

Regular physical activity may help reduce the risk of prostate cancer and slow the progression of the disease.

Frequent ejaculations from masturbation or sexual activity have been associated with a lower risk for prostate cancer.

• Interruption of urinary stream (stopping and starting)
• Frequent urination (especially at night)
• Pain or burning during urination
• Weak urinary stream
• Inability to urinate
• Blood in the urine

• Significant pain in one or more bones may indicate spread of disease. It may be accompanied by significant weight loss.

Benign prostatic hypertrophy (BPH) is a non-cancerous enlargement of the prostate gland, commonly found in men over the age of 50.

Prostatitis is an inflammation of the prostate, sometimes accompanied by fever or blood in the urine.

Screening and Diagnosis

• Men ages 50 - 70 should be offered annual screening. (Some experts believe that men whose PSA levels are under 1.0 and possibly under 2.0 may safely be screened only every 2 years thereafter.)
• Men with a family history of prostate cancer and all African-American men should consider annual screening at about age 45.
• PSA testing is generally not recommended for men over age 75.
• PSA test. The PSA blood test measures the level of a protein called prostate-specific antigen
• Digital rectal examination (DRE). The DRE is a physical examination. The doctor inserts a finger into the patients rectum and feels the prostate for bumps or other abnormalities.

Is used if the DRE indicates the presence of cancer.

Can actually confirm a diagnosis of prostate cancer.PSA level of 4.0 ng/mL or higher - should take a second PSA test several weeks afterward before having a biopsy, since many non-malignant factors can increase PSA levels.

• Bone Scans and X-Rays. Patients with PSA levels below 20 ng/mL are unlikely to have scans that show cancer in the bone.
• Computed Tomography and Magnetic Resonance Imaging. To map the disease spread beyond the prostate.

Treatment choices are generally based on the patients age, the stage and grade of the cancer, overall health status, and the patients personal preferences for the risks and benefits of each therapy.

• Active surveillance, also called watchful waiting, involves monitoring the tumor for cancer progression.
• Surgery (radical prostatectomy) removes the prostate gland. Particularly for younger men with aggressive tumors. It is usually not appropriate for older men.
• Radiation therapy targets the tumor either externally or internally .
• Androgen therapy also called hormone therapy uses orchiectomy (surgical removal of the testicles) or drugs to stop production of male hormones.

• A sudden rise or persistently elevated PSA levels after treatment are often indications that prostate cancer persists.
• If PSA levels are above 2.0 ng/mL, then cancer is most likely still present.

Pelvic lymphadenectomy is the surgical removal of the pelvic lymph nodes. The lymph nodes are removed through an incision in the lower part of the abdomen, using conventional surgery or laparoscopy, a less invasive variation. The nodes are immediately examined. If they show signs of cancer, metastasis has occurred. In such cases, the operation is usually stopped and the patient is offered radiation or hormone treatments.

Transurethral resection of the prostate (TURP) involves removing a section of the prostate and is used to control urinary symptoms in men who are not good candidates for curative therapy due to advanced age.

• Older patients with medical problems.
• Cancer has extended beyond the prostate capsule but has not spread to the lymph nodes or further

• Orchiectomy is the surgical removal of the testicles.

• The main anti-androgen drugs include:
  • Flutamide
  • Nilutamide
  • Bicalutamide (Casodex)

• Never been screened for prostate cancer
• A family history of prostate cancer