Prostate cancer overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]
Overview
Prostate cancer is the development of cancer in the prostate, a gland in the male reproductive system. It was first described in 1536 by Niccolò Massa. On microscopic histopathological analysis, increased gland density, small circular glands, basal cells lacking, and cytological abnormalities are characteristic findings of prostate cancer. It must be differentiated from benign prostatic hypertrophy, renal cancer, renal stones, bladder cancer, and cystitis. In 2012, the prevalence of prostate cancer was estimated to be 2,800 cases per 100,000 men in the United States. The incidence of prostate cancer is approximately 137.9 per 100,000 individuals worldwide. Common symptoms of prostate cancer include changes in bladder habits, hematuria, hematospermia, and painful ejaculation.[1]
Historical Perspective
Prostate cancer was first described in 1536 by Niccolò Massa. In 1983, radical retropubic prostatectomy[2] was first developed by Patrick Walsh to treat prostate cancer. In 1941, the first use of estrogen was developed by Charles B. Huggins to oppose testosterone production in men with metastatic prostate cancer. In the early 20th, radiation therapy was first developed to treat prostate cancer. In the 1970s, systemic chemotherapy was first studied to treat prostate cancer.[3]
Pathophysiology
On microscopic histopathological analysis, increased gland density, small circular glands, basal cells lacking, and cytological abnormalities are characteristic findings of prostate cancer.
Causes
There are no established causes for prostate cancer. To review risk factors for the development of prostate cancer click here.
Differential Diagnosis
Prostate cancer must be differentiated from benign prostatic hypertrophy, renal cancer, renal stones, bladder cancer, and cystitis.
Epidemiology and Demographics
In 2012, the prevalence of prostate cancer was estimated to be 2,800 cases per 100,000 men in the United States. The incidence of prostate cancer is approximately 109.8 per 100,000 individuals worldwide. It usually affects individuals of the African American race. Asian, Hispanic, and White individuals are less likely to develop prostate cancer. The incidence of prostate cancer increases with age; the median age at diagnosis is 66 years.[4]
Risk Factors
Common risk factors in the development of prostate cancer are Age, Ethnicity, Diet (Animal fat, vegetables, Lycopene and tomato-based products, Soy intake), omega 3-fatty acids, caffeine, Vitamins and minerals (Multivitamins, Folic acid and Vitamin B12, selenium, zinc, Calcium and Vitamin D), Cigarette Smoking, Hormones levels and Obesity (Sex hormones, Insulin and Insulin-like growth factor, Physical activity), Other factors like 5 Alpha reductase inhibitor, Prostatitis, Trichomonas Vaginalis infection, Environmental Carcinogen(Agent Orange, Choldecon, Bisphenol A), NSAIDS, Vasectomy, Ultraviolet light exposure, EBRT for rectal cancer.
Screening
According to the U.S. Preventive Services Task Force (USPSTF), there is insufficient evidence to recommend routine screening for prostate cancer. According to the American Cancer Society (ACS) guidelines, screening for prostate cancer by prostate specific antigen (PSA) and digital rectal exam (DRE) is recommended once among individuals age 50 years, age 45 years for African-American men and men with a family history of prostate cancer, and age 40 years for men with a very strong family history of prostate cancer.They should be retested every year if the prostate specific antigen is 2.5ng/ml or more and once every 2 years if less than 2.5mg/ml. According to the American Urological Association (AUA) guidelines, screening for prostate cancer by PSA is recommended every 2 years among individuals age 55 to 69 years, or younger than 55 years for individuals with high risk.[5]
Prognosis
Prognosis of prostate cancer is generally good, and the 5-year survival rate is approximately 98.9%. The prognosis varies with the stage of tumor; Localized and regional tumors have the most favorable prognosis.
History and Symptoms
Common symptoms of prostate cancer include changes in bladder habits, hematuria, hematospermia, and painful ejaculation.[6]
Physical Examination
Common physical examination findings of prostate cancer include cachexia, pallor, anesthesia in the lower limbs, paresis in the lower limbs, lower-extremity lymphedema, bony tenderness, suprapubic palpation of the bladder, and an asymmetrical boggy mass with the change of texture may be palpated in the anterior wall of the rectum.[7]
Staging
Prostate cancer may be classified into several subtypes based on TNM system and UICC.
Laboratory Studies
Laboratory findings consistent with the diagnosis of prostate cancer include elevated serum prostate-specific antigen level, low red blood cell count, elevated blood urea nitrogen, and elevated serum creatinine. Some patients may have elevated concentration of serum calcium and alkaline phosphatase, which is usually suggestive of bone metastases.
X-ray
There are no X-ray findings associated with prostate cancer.
CT
There are no CT scan findings associated with in situ prostate cancer. CT scan may be helpful in the diagnosis of bone metastasis of prostate cancer.
MRI
MRI may be helpful in the diagnosis of prostate cancer. On an MRI scan, prostate cancer is characterized by a low signal within a normally high signal peripheral zone on T2-weighted images.
Ultrasound
On ultrasound, prostate cancer is characterized by hypoechoic areas.[8]
Other Imaging Findings
Radionuclide may be helpful in the diagnosis of the bone metastasis of prostate cancer.
Other Diagnostic Studies
There are no other diagnostic study findings associated with prostate cancer.
Biopsy
Biopsy may be helpful in the diagnosis of prostate cancer. Findings on biopsy suggestive of prostate cancer include increased gland density, small circular glands, basal cells lacking, and cytological abnormalities.
Medical Therapy
The predominant therapy for prostate cancer is surgical resection. Adjunctive chemotherapy, radiation[9], hormonal therapy, bisphosphonates, and analgesics may be required.
Surgery
Surgery is the mainstay of treatment for prostate cancer.
Primary Prevention
Effective measures for the primary prevention of prostate cancer include healthy diet and maintaining a healthy weight.
Secondary Prevention
There are no specific secondary preventive measures available but healthy lifestyle practices may decrease the overall mortality in prostate cancer patients.[10]
References
- ↑ Denmeade SR, Isaacs JT (2002). "A history of prostate cancer treatment". Nat Rev Cancer. 2 (5): 389–96. doi:10.1038/nrc801. PMC 4124639. PMID 12044015.
- ↑ Walsh PC, Lepor H, Eggleston JC (1983). "Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations". Prostate. 4 (5): 473–85. doi:10.1002/pros.2990040506. PMID 6889192.
- ↑ Scott WW, Johnson DE, Schmidt JE, Gibbons RP, Prout GR, Joiner JR; et al. (1975). "Chemotherapy of advanced prostatic carcinoma with cyclophosphamide or 5-fluorouracil: results of first national randomized study". J Urol. 114 (6): 909–11. doi:10.1016/s0022-5347(17)67172-6. PMID 1104900.
- ↑ "Prostate Cancer - Cancer Stat Facts".
- ↑ Carter HB (2013). "American Urological Association (AUA) guideline on prostate cancer detection: process and rationale". BJU Int. 112 (5): 543–7. doi:10.1111/bju.12318. PMID 23924423.
- ↑ Signs and symptoms of prostate cancer.2015 Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/prostate/signs-and-symptoms/?region=ab
- ↑ Hamilton W, Sharp D (August 2004). "Symptomatic diagnosis of prostate cancer in primary care: a structured review". Br J Gen Pract. 54 (505): 617–21. PMC 1324845. PMID 15296564.
- ↑ Mitterberger M, Horninger W, Aigner F, Pinggera GM, Steppan I, Rehder P, Frauscher F (March 2010). "Ultrasound of the prostate". Cancer Imaging. 10: 40–8. doi:10.1102/1470-7330.2010.0004. PMC 2842183. PMID 20199941.
- ↑ National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publications/pdq
- ↑ Chan JM, Van Blarigan EL, Kenfield SA (2014). "What should we tell prostate cancer patients about (secondary) prevention?". Curr Opin Urol. 24 (3): 318–23. doi:10.1097/MOU.0000000000000049. PMC 4084902. PMID 24625429.