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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | __NOTOC__ |
| | '''For patient information click [[Prostate cancer (patient information)|here]].''' |
| | {{Prostate cancer}} |
| | {{SCC}}; {{MJM}}; {{AE}} {{SC}} {{sali}} {{KKV}} |
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| {{DiseaseDisorder infobox | | | {{SK}} Prostate adenocarcinoma, neoplasm of prostate, tumor of prostate, tumor of prostate, malignant tumor of the prostate, cancer of the prostate, malignant prostatic tumor, malignant prostatic tumour, malignant tumor of prostate |
| Name = Prostate cancer |
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| ICD10 = {{ICD10|C|61||c|60}} |
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| ICD9 = {{ICD9|185}} |
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| Image = Prostatelead.jpg |
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| Caption = |
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| ICDO = |
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| OMIM = 176807 |
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| DiseasesDB = 10780 |
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| MedlinePlus = 000380 |
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| MeshID = D011471 |
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| }} | |
| {{Prostate cancer}}
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| {{SCC}}
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| {{Editor Join}}
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| ==[[Prostate cancer overview|Overview]]== | | ==[[Prostate cancer overview|Overview]]== |
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| ==[[Prostate cancer history and symptoms|Symptoms]]== | | ==[[Prostate cancer historical perspective|Historical Perspective]]== |
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| | ==[[Prostate cancer classification|Classification]]== |
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| ==[[Prostate cancer pathophysiology|Pathophysiology]]== | | ==[[Prostate cancer pathophysiology|Pathophysiology]]== |
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| ==[[Prostate cancer causes|Causes]]== | | ==[[Prostate cancer causes|Causes]]== |
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| ==Treatment== | | ==[[Prostate cancer differential diagnosis|Differentiating Prostate Cancer from other Cancers]]== |
| [[Prostate cancer medical therapy|Medical therapy]] | [[Prostate cancer surgery|Surgical options]] | [[Prostate cancer metastasis treatment|Metastasis Treatment]] | [[Prostate cancer primary prevention|Primary prevention]] | [[Prostate cancer secondary prevention|Secondary prevention]] | [[Prostate cancer cost-effectiveness of therapy|Financial costs]] | [[Prostate cancer future or investigational therapies|Future therapies]]
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| ==[[Prostate cancer screening|Screening]]== | |
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| ==Diagnosis==
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| [[Image:Prostatehistopath.jpg|thumb|right|500px|'''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.]]
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| When a man has symptoms of prostate cancer, or a screening test indicates an increased risk for cancer, more invasive evaluation is offered.
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| 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.
| | ==[[Prostate cancer epidemiology and demographics|Epidemiology and Demographics]]== |
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| :[[Prostate cancer history and symptoms| History and Symptoms]] | [[Prostate cancer physical examination | Physical Examination]] | [[Prostate cancer staging | Staging]] | [[Prostate cancer laboratory studies | Lab Studies]] | [[Prostate cancer electrocardiogram|Electrocardiogram]] | [[Prostate cancer x ray|X Ray]] | [[Prostate cancer MRI|MRI]] | [[Prostate cancer CT|CT]] | [[Prostate cancer echocardiography|Echocardiography]] | [[Prostate cancer other imaging findings|Other imaging findings]] | [[Prostate cancer other diagnostic studies|Other diagnostic studies]]
| | ==[[Prostate cancer risk factors|Risk Factors]]== |
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| ==Risk assessment== | | ==[[Prostate cancer screening|Screening]]== |
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| 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.
| | ==[[Prostate cancer natural history|Natural History, Complications and Prognosis]]== |
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| 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.
| | ==Diagnosis== |
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| 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.
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| 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.
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| The [http://urology.ucsf.edu 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 [http://www.capsure.net CaPSURE] database. It has been validated among over 10,000 prostatectomy patients, including patients from CaPSURE; the SEARCH registry, representing data from several Veterans Administration and active military medical centers; a multi-institutional cohort in Germany; and the prostatectomy cohort at Johns Hopkins University.
| | [[Prostate cancer history and symptoms| History and Symptoms]] | [[Prostate cancer physical examination | Physical Examination]] | [[Prostate cancer staging | Staging]] | [[Prostate cancer laboratory studies | Laboratory Findings]] | [[Prostate cancer x ray|X Ray]] | [[Prostate cancer CT|CT]] | [[Prostate cancer MRI|MRI]] | [[Prostate cancer ultrasound| Ultrasound]] | [[Prostate cancer other imaging findings|Other Imaging Findings]] | [[Prostate cancer other diagnostic studies|Other Diagnostic Studies]] | [[Prostate cancer biopsy|Biopsy]] |
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| ==Treatment== | | ==Treatment== |
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| Treatment for prostate cancer may involve [[watchful waiting]], [[surgery]], [[radiation therapy]] including [[brachytherapy]] (prostate brachytherapy) and external beam radiation, [[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 [[Adverse effect (medicine)|side effect]]s, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations.
| | [[Prostate cancer medical therapy|Medical Therapy]] | [[Prostate cancer surgery|Surgery]] | [[Prostate cancer primary prevention|Primary Prevention]] | [[Prostate cancer secondary prevention|Secondary Prevention]] | [[Prostate cancer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Prostate cancer future or investigational therapies|Future or Investigational Therapies]] | [[Prostate cancer alternative therapy|Alternative Therapy]] |
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| 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.<ref name="pmid16314889">{{cite journal | author = Mouraviev V, Evans B, Polascik TJ | title = Salvage prostate cryoablation after primary interstitial brachytherapy failure: a feasible approach | journal = Prostate Cancer Prostatic Dis. | volume = 9 | issue = 1 | pages = 99–101 | year = 2006 | pmid = 16314889 | doi = 10.1038/sj.pcan.4500853 | url = }}</ref> This may enter into the treatment decision.
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| If the cancer has spread beyond the prostate, treatment options significantly change, so most doctors who treat prostate cancer use a variety of [[nomogram]]s 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.
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| ===Active Surveillance===
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| Active Surveillance refers to observation and regular monitoring without invasive treatment. Active surveillance is often used when an early stage, slow-growing prostate cancer is found in an older man. Conversely [[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 active surveillance for early stage tumors eventually have signs of tumor progression, and they may need to begin treatment within three years.<ref>{{cite journal| last=Wu| first=H| coauthors=Sun L, Moul JW, Wu HY, McLeod DG, Amling C, Lance R, Kusuda L, Donahue T, Foley J, Chung A, Sexton W, Soderdahl D| title=Watchful waiting and factors predictive of secondary treatment of localized prostate cancer| journal=J Urol| year=2004| month=March| volume=171| issue=3| pages=1111–6| pmid=14767282| doi=10.1097/01.ju.0000113300.74132.8b}}</ref> Although men who choose active surveillance avoid the risks of surgery and radiation, the risk of metastasis (spread of the cancer) may be increased.
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| 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.
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| ===Natural Therapy===
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| As an alternative to active surveillance or invasive treatments, which does nothing to change the course of disease, a growing number of clinicians and researchers are looking at non-invasive ways to help men with apparently localized prostate cancer. Perhaps most convincing among this group are Dean Ornish, MD and colleagues, previously made famous for showing that aggressive lifestyle changes can reverse atherosclerosis, and now showing that PSA can be lowered in men with apparent localized prostate cancer using a vegan diet (fish allowed), regular exercise, and stress reduction.<ref>{{cite journal | last=Ornish| first=D| coauthors=Weidner G, Fair WR, et al.| title=Intensive lifestyle changes may affect the progression of prostate cancer| journal=J Urol| year=2005| volume=174| issue=3| pages=1065–70| pmid=16094059}}</ref> These results have so far proven durable after two-years' treatment.<ref>{{cite journal| last=Frattaroli| first=J| coauthors=Weidner G, Kemp C, et al.| title=Clinical events in Prostate CAncer Lifestyle Trial: Results from two years of follow-up| journal=Urology| year=2008| month=July| pmid= 18602144| volume=epub ahead of print}}</ref>
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| Many other single agents have been shown to reduce PSA, slow PSA doubling times, or have similar effects on secondary markers in men with localized cancer in short term trials, such as the Wonderful variety of pomegranate juice 8 oz daily or genistein, an isoflavone found in various legumes, 60 mg per day.<ref>{{cite journal| last=Pantuck| first=AJ| coauthors=Leppert JT, Zomorodian N, et al.| title=Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer| journal=Clin Cancer Res| year=2006| volume=12| issue=13| pages=4018–26| pmid=16818701}}</ref><ref>{{cite journal| last=Kumar| first=NB| coauthors=Cantor A, Allen K, et al.| title=The specific role of isoflavones in reducing prostate cancer risk| journal=Prostate| year=2004| volume=59| issue=2| pages=141–7| pmid= 15042614}}</ref> The potential of using multiple such agents in concert, let alone combining them with lifestyle changes, has not yet been studied but the potential is great. This is particularly true because most of these natural approaches have very low adverse effect rates, and in fact tend to help other risk factors and disease conditions such as atherosclerosis, diabetes, and risk for other cancers at the same time they are helping slow down prostate cancer. A more thorough review of natural approaches to prostate cancer has been published.<ref>{{cite journal| last=Yarnell| first=E| title=A naturopathic approach to prostate cancer. Part 2: Guidelines for treatment and prevention| journal=Altern Complemen Ther| year=1999| volume=5| issue=6| pages=360–8}}</ref>
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| ===Surgery===
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| 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.
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| [[Radical prostatectomy]] is effective for tumors which have not spread beyond the prostate;<ref name="pmid15888698">{{cite journal |author=Bill-Axelson A, Holmberg L, Ruutu M, ''et al'' |title=Radical prostatectomy versus watchful waiting in early prostate cancer |journal=N. Engl. J. Med. |volume=352 |issue=19 |pages=1977–84 |year=2005 |pmid=15888698 |doi=10.1056/NEJMoa043739}}</ref> 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.
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| 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.
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| Laparoscopic radical prostatectomy, LRP, is a new way to approach the prostate surgically with intent to cure. 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.
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| 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.<ref name="pmid17936849">{{cite journal |author=Smith JA, Chan RC, Chang SS, ''et al'' |title=A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy |journal=J. Urol. |volume=178 |issue=6 |pages=2385–9; discussion 2389–90 |year=2007 |pmid=17936849 |doi=10.1016/j.juro.2007.08.008 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5347(07)01979-9}}</ref> 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). The relative merits of RALP and benefits over open radical prostatectomy are an area of intense research currently in urology and no definitive data, that has been widely accepted by the broader urological community, exists to say it is superior to a open radical retropubic prostatectomy.
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| [[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 instrument ([[cystoscope]]) is placed into the penis and the blocking prostate is cut away.
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| In metastatic disease, where cancer has spread beyond the prostate, removal of the [[testicle]]s (called [[orchiectomy]]) may be done to decrease testosterone levels and control cancer growth. (See hormonal therapy, below).
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| The most common serious complications of surgery are loss of [[urinary incontinence|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 reduce urinary incontinence and impotence.<ref>{{cite journal| last=Gerber| first=GS| coauthors=Thisted RA, Scardino PT, Frohmuller HG, Schroeder FH, Paulson DF, Middleton AW Jr, Rukstalis DB, Smith JA Jr, Schellhammer PF, Ohori M, Chodak GW| title=Results of radical prostatectomy in men with clinically localized prostate cancer| journal=JAMA| year=1996| month=August 28| volume=276| issue=8| pages=615–9| pmid=8773633| doi=10.1001/jama.276.8.615}}</ref>
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| ===Radiation therapy===
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| [[Image:brachytherapy.jpg|thumb|left|250px|'''[[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 radiotherapy|external beam radiation therapy]] and [[brachytherapy]] (specifically prostate brachytherapy).
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| 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 than traditional treatment. One of these is [[Tomotherapy]].
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| [[Image:linacprostate.jpg|thumb|right|150px|[[External beam radiotherapy|External beam radiation therapy]] for prostate cancer is delivered by a linear accelerator, such as this one.]]
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| 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<ref>{{cite journal| last=Nag| first=S| coauthors=Beyer D, Friedland J, Grimm P, Nath R| title=American Brachytherapy Society Recommendations for Transperineal Permanent Brachytherapy of Prostate Cancer | journal=Int. J. Rad. Onc. Biol. Phys. | year=1999| month=?| volume=44| issue=4| pages=789–799| id=?}} Review.</ref> 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 [[Superficial X-ray|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.<ref>{{cite journal| last=Perez| first=CA| coauthors=Hanks GE, Leibel SA, Zietman AL, Fuks Z, Lee WR| title=Localized carcinoma of the prostate (stages T1B, T1C, T2, and T3). Review of management with external beam radiation therapy| journal=Cancer| year=1993| month=December 1| volume=72| issue=11| pages=3156–73| pmid=7694785| doi=10.1002/1097-0142(19931201)72:11<3156::AID-CNCR2820721106>3.0.CO;2-G}} Review.</ref>
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| 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.<ref>{{cite journal | author=D'Amico AV, Manola J, Loffredo M, Renshaw AA, DellaCroce A, Kantoff PW | title=6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial | journal=JAMA | year=2004 | pages=821–7 | volume=292 | issue=7 | pmid=15315996 | doi = 10.1001/jama.292.7.821}}</ref> Others use a "triple modality" combination of external beam radiation therapy, brachytherapy, and hormonal therapy.
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| Radiation therapy uses high-energy rays or particles to kill cancer cells.<ref>[http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_36.asp?rnav=cri American Cancer Society: Radiation Treatment]</ref>
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| When delivered in the correct dosage, radiation can reduce the risk of recurrence.
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| 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.
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| 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.
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| Side effects of radiation therapy might occur after a few weeks into treatment. Both types of radiation therapy may cause [[diarrhea]] and mild [[Gastrointestinal bleeding|rectal bleeding]] due to [[radiation proctitis]], as well as urinary incontinence and impotence. Symptoms tend to improve over time. Rates for impotence when comparing radiation to nerve-sparing surgery are similar. Radiation has lower rates of incontinence but higher rates of occasional mild rectal bleeding.<ref>{{cite journal| last=Lawton| first=CA| coauthors=Won M, Pilepich MV, Asbell SO, Shipley WU, Hanks GE, Cox JD, Perez CA, Sause WT, Doggett SR, et al| title=Long-term treatment sequelae following external beam irradiation for adenocarcinoma of the prostate: analysis of RTOG studies 7506 and 7706| journal=Int J Radiat Oncol Biol Phys| year=1991| month=September| volume=21| issue=4| pages=935–9| pmid=1917622}}</ref> Men who have undergone external beam radiation therapy may have a slightly higher risk of later developing [[colon cancer]] and [[bladder cancer]].<ref>{{cite journal| last=Brenner| first=DJ| coauthors=Curtis RE, Hall EJ, Ron E| title=Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery| journal=Cancer| year=2000| month=January 15| volume=88| issue=2| pages=398–406| pmid=10640974| doi=10.1002/(SICI)1097-0142(20000115)88:2<398::AID-CNCR22>3.0.CO;2-V}}</ref>
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| ===Cryosurgery===
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| [[Cryosurgery]] is another method of treating prostate cancer in which the prostate gland is exposed to freezing temperatures.<ref>PreventProstateCancer.info: A Brief Overview of Prostate Cancer [http://www.preventprostatecancer.info/Articles/files/5e098219e5c93597247a2f997a4c677f-1.html]</ref> It is less invasive than radical prostatectomy, and [[general anesthesia]] is less commonly used. Under ultrasound guidance, a method invented by Dr. Gary Onik,<ref>{{cite web | title=Cryosurgical system for destroying tumors by freezing | url=http://www.patentstorm.us/patents/5334181.html | accessdate= 1994-08-02}}</ref> 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 −186 °[[Celsius|C]] (−302 °[[Fahrenheit|F]]). As the water within the prostate cells freeze, the cells die. The [[urethra]] is protected from freezing by a [[Foley catheter|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.<ref>{{cite journal| last=Bahn| first=DK| coauthors=Lee F, Badalament R, Kumar A, Greski J, Chernick M| title=Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer| journal=Urology| year=2002| month=August| volume=60| issue=2 Suppl 1| pages=3–11| pmid=12206842| doi=10.1016/S0090-4295(02)01678-3}}</ref> Cryosurgery has also been demonstrated to be superior to radical prostatectomy for recurrent cancer following radiation therapy. | |
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| ===Hormonal therapy===
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| [[Image:prostatehormone.jpg|right|thumb|200px|'''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.]]
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| [[Hormonal therapy (oncology)|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.<ref>{{cite journal| last=Robson| first=M| coauthors=Dawson N| title=How is androgen-dependent metastatic prostate cancer best treated?| journal=Hematol Oncol Clin North Am| year=1996| month=June| volume=10| issue=3| pages=727–47| pmid=8773508| doi=10.1016/S0889-8588(05)70364-6}} Review.</ref>
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| 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 gland]]s stimulate the prostate to produce more DHT. Hormonal therapy can decrease levels of DHT by interrupting this pathway at any point.
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| There are several forms of hormonal therapy:
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| *[[Castration|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.
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| *[[Antiandrogens]] are medications such as [[flutamide]], [[bicalutamide]], [[nilutamide]], and [[cyproterone acetate]] which directly block the actions of testosterone and DHT within prostate cancer cells.
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| *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.
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| *GnRH action can be interrupted in one of two ways. [[Gonadotropin-releasing hormone analog|GnRH antagonists]] suppress the production of LH directly, while [[Gonadotropin-releasing hormone analog|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.<ref>{{cite journal| last=Loblaw| first=DA| coauthors=Mendelson DS, Talcott JA, Virgo KS, Somerfield MR, Ben-Josef E, Middleton R, Porterfield H, Sharp SA, Smith TJ, Taplin ME, Vogelzang NJ, Wade JL Jr, Bennett CL, Scher HI; American Society of Clinical Oncology| title=American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer| journal=J Clin Oncol| year=2004| month=July 15| volume=22| issue=14| pages=2927–41| pmid=15184404| doi=10.1200/JCO.2004.04.579}} Erratum in: J Clin Oncol. 2004 November 1;22(21):4435.</ref>
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| *A very recent Trial I study (N=21) found that [[Abiraterone|Abiraterone Acetate]] caused dramatic reduction in [[PSA]] levels and [[Tumor]] sizes in aggressive end-stage prostate cancer for 70% of patients. This is prostate cancer that resists all other treatments (e.g., castration, other hormones, etc.). Officially the impacts on life-span are not yet known because subjects have not been taking the drug very long. Larger Trial III Clinical Studies are in the works. If successful an approved treatment is hoped for around 2011.<ref>{{cite journal| last=de Bono| first=Johann| coauthors= Gerhardt Attard, Alison H.M. Reid, Timothy A. Yap, Florence Raynaud, Mitch Dowsett, Sarah Settatree, Mary Barrett, Christopher Parker, Vanessa Martins, Elizabeth Folkerd, Jeremy Clark, Colin S. Cooper, Stan B. Kaye, David Dearnaley, Gloria Lee | title= Phase I Clinical Trial of a Selective Inhibitor of CYP17, Abiraterone Acetate, Confirms That Castration-Resistant Prostate Cancer Commonly Remains Hormone Driven| url = http://jco.ascopubs.org/cgi/content/abstract/JCO.2007.15.9749v1 | journal=J Clin Oncol| year=2004| month=July 21| volume= | issue= | pages= online| pmid=15184404| doi=10.1200/JCO.2007.15.9749| nopp=true}} Erratum in: J Clin Oncol. Early Release, published ahead of print July 21, 2008</ref><ref>{{ cite news | author = Richard Warry | title = Drug for deadly prostate cancer | url = http://news.bbc.co.uk/2/hi/health/7517414.stm | publisher = [[BBC]] | date = July 22, 2008 | accessdate = 2008-07-23 }}</ref>
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| 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.
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| 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 flush|hot flashes]], weight gain, loss of [[libido]], enlargement of the [[breast]]s ([[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 [[thrombosis|blood clots]]. The antiandrogens do not generally cause impotence and usually cause less loss of bone and muscle mass. Ketoconazole can cause [[Hepatotoxicity|liver damage]] with prolonged use, and aminoglutethimide can cause skin [[rash]]es.
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| === Palliative care ===
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| [[Palliative care]] for advanced stage prostate cancer focuses on extending life and relieving the symptoms of metastatic disease. As noted above [[Abiraterone|Abiraterone Acetate]] is showing some promise in treating advance stage prostate cancer. It causes a dramatic reduction in [[Prostate specific antigen|PSA]] levels and [[Tumor]] sizes in aggressive advanced-stage prostate cancer for 70% of patients. [[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]].<ref>{{cite journal| last=Tannock| first=IF| coauthors=de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN, Oudard S, Theodore C, James ND, Turesson I, Rosenthal MA, Eisenberger MA; TAX 327 Investigators| title=Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer| journal=N Engl J Med| year=2004| month=October 7| volume=351| issue=15| pages=1502–12| pmid=1547021| doi=10.1056/NEJMoa040720}}</ref> [[Bisphosphonates]] such as [[zoledronic acid]] have been shown to delay skeletal complications such as [[fracture]]s or the need for radiation therapy in patients with hormone-refractory metastatic prostate cancer.<ref>{{cite journal | author=Saad F, Gleason DM, Murray R, Tchekmedyian S, Venner P, Lacombe L, Chin JL, Vinholes JJ, Goas JA, Chen B | title=A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma | journal=J Natl Cancer Inst | year=2002 | pages=1458–68 | volume=94 | issue=19 | pmid=12359855}}</ref>
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| [[Bone pain]] due to metastatic disease is treated with [[opioid]] [[Analgesic|pain relievers]] such as [[morphine]] and [[oxycodone]]. External beam radiation therapy directed at bone metastases may provide [[pain]] relief. Injections of certain [[radioisotope]]s, such as [[strontium-89]], [[phosphorus-32]], or [[samarium-153-ethylene diamine tetramethylene phosphonate|samarium-153]], also target bone metastases and may help relieve pain.
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| ===High Intensity Focused Ultrasound (HIFU)===
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| [[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 100 °[[Celsius|C]] (212 °[[Fahrenheit|F]]).<ref name="Thomas-A">Thomas A. Gardner and Michael A Koch, Indiana University Medical Center, Indianapolis. Prostate Cancer Therapy with High-Intensity Focused Ultrasound-Comprehensive Review. Clinical Genitourinary Cancer Vol 4. No.3, 2005.</ref> 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)<ref name="Toyoaki-Uchida">Toyoaki Uchida, et al. Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer. Dept of Urology University of Tokai Hachioji Hospital. International Journal of Urology</ref> 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 ng/mL were cancer-free after three years.<ref name="Toyoaki-Uchida"/> However, many studies of HIFU were performed by manufacturers of HIFU devices, or members of manufacturers' advisory panels.<ref>Tom Pickles, Larry Goldenberg, Gary Steinhoff. High Intensity Focused Ultrasound for Prostate Cancer. British Columbia Cancer Agency http://www.bccancer.bc.ca/NR/rdonlyres/08EA1C8E-4345-4C7E-A83A-1F84853A1C27/8101/HIFUreport2005Feb10revised1.pdf</ref>
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| HIFU was first used in the 1940s and 1950s 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.<ref name="Thomas-A"/> Today, the HIF 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.
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| 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.
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| 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.
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| ==Prognosis==
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| 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 occurrence of prostate cancer).<ref>[http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_prostate_cancer_36.asp ACS :: What Are The Risk Factors for Prostate Cancer?<!-- Bot generated title -->]</ref> 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.<ref>{{cite journal| last=Jemal| first=A| coauthors=Murray T; Ward E; Samuels A; Tiwari RC; Ghafoor A; Feuer EJ; Thun MJ| title=Cancer statistics, 2005| journal=CA Cancer J Clin| year=2005| month=Jan-Feb| volume=55| issue=1| pages=10–30| pmid=15661684}} Erratum in: CA Cancer J Clin. 2005 Jul-Aug;55(4):259.</ref> In Japan, death from prostate cancer was one-fifth to one-half the rates in the United States and Europe in the 1990s.<ref>{{cite journal| last=Wakai| first=K| title=Descriptive epidemiology of prostate cancer in Japan and Western countries| journal=Nippon Rinsho| year=2005| month=February| volume=63| issue=2| pages=207–12| pmid=15714967}} Review. {{Ja icon}}</ref> In India in the 1990s, half of the people with prostate cancer confined to the prostate died within ten years.<ref>{{cite journal| last=Yeole| first=BB| coauthors=Sunny L| title=Population based survival from prostate cancer in Mumbai (Bombay), India| journal=Indian J Cancer| year=2001| month=Jun-Dec| volume=38| issue=2–4| pages=126–32| pmid=1259345}}</ref> African-American men have 50–60 times more prostate cancer and prostate cancer deaths than men in Shanghai, China.<ref>{{cite journal| last=Hsing| first= AW| coauthors=Tsao L, Devesa SS| title=International trends and patterns of prostate cancer incidence and mortality| journal=Int J Cancer| year=2000| month=January 1| volume=85| issue=1| pages=60–7| pmid=10585584| doi=10.1002/(SICI)1097-0215(20000101)85:1<60::AID-IJC11>3.0.CO;2-B}}</ref> In Nigeria, two percent of men develop prostate cancer and 64% of them are dead after two years.<ref>{{cite journal| last=Osegbe| first=DN| title=Prostate cancer in Nigerians: facts and nonfacts| journal=J Urol| year=1997| month=April| volume=157| issue=4| pages=1340–3| pmid=9120935| doi=10.1016/S0022-5347(01)64966-8}}</ref>
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| 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. [[Nomogram]]s 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.<ref>{{cite journal | author=Di Blasio CJ, Rhee AC, Cho D, Scardino PT, Kattan MW | title=Predicting clinical end points: treatment nomograms in prostate cancer | journal=Semin Oncol | year=2003 | pages=567–86 | volume=30 | issue=5 | pmid=14571407 | doi=10.1016/S0093-7754(03)00351-8}}</ref>
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| ==Progression==
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| In 1941, Charles Huggins reported that [[androgen]] ablation therapy causes regression of primary and metastatic androgen-dependent prostate cancer.<ref>Huggins C, Steven RE and Hodges CV, Studies on prostatic cancer. Arch. Sug. 43:209–223, 1941.</ref> [[Androgen]] ablation therapy causes remission in 80-90% of patients undergoing therapy, resulting in a median progression-free survival of 12 to 33 months. After remission an androgen-independent phenotype typically emerges, where the median overall survival is 23–37 months from the time of initiation of [[androgen]] ablation therapy.<ref>Hellerstedt BA and Pienta KJ, The current state of hormonal therapy for prostate cancer, CA Cancer J. Clin. 52: 154–179, 2002.PMID 12018929</ref> The actual mechanism contributes to the progression of prostate cancer is not clear and may vary between individual patient. A few possible mechanisms have been proposed.<ref>Feldman BJ, Feldman D. The development of androgen-independent prostate cancer. Nat Rev Cancer. 2001 Oct;1(1):34–45. PMID 11900250</ref> 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 [[tumor]]s in patients.<ref>Linja MJ, Savinainen KJ, Saramaki OR, Tammela TL, Vessella RL, Visakorpi T. Amplification and overexpression of androgen receptor gene in hormone-refractory prostate cancer. Cancer Res. 2001 May 1;61(9):3550–5. PMID 11325816</ref><ref>Ford OH 3rd, Gregory CW, Kim D, Smitherman AB, Mohler JL. Androgen receptor gene amplification and protein expression in recurrent prostate cancer. J Urol. 2003 Nov;170(5):1817–21.PMID 14532783</ref> 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. [[Androgen]]s paradoxically inhibit the proliferation of these [[androgen]]-independent prostate [[cancer]] cells.<ref>Kokontis J, Takakura K, Hay N, Liao S. Increased androgen receptor activity and altered c-myc expression in prostate cancer cells after long-term androgen deprivation. Cancer Res. 1994 March 15;54(6):1566–73. PMID 7511045</ref><ref>Umekita Y, Hiipakka RA, Kokontis JM, Liao S. Human prostate tumor growth in athymic mice: inhibition by androgens and stimulation by finasteride. Proc Natl Acad Sci U S A. 1996 October 15;93(21):11802-7. PMID 8876218</ref><ref>Kokontis JM, Hsu S, Chuu CP, Dang M, Fukuchi J, Hiipakka RA, Liao S. Role of androgen receptor in the progression of human prostate tumor cells to androgen independence and insensitivity. Prostate. 2005 December 1;65(4):287-98. PMID 16015608</ref> [[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.<ref>Chuu CP, Hiipakka RA, Fukuchi J, Kokontis JM, Liao S. Androgen causes growth suppression and reversion of androgen-independent prostate cancer xenografts to an androgen-stimulated phenotype in athymic mice. Cancer Res. 2005 March 15;65(6):2082–4. PMID 15781616 </ref><ref>Chuu CP, Hiipakka RA, Kokontis JM, Fukuchi J, Chen RY, Liao S. Inhibition of tumor growth and progression of LNCaP prostate cancer cells in athymic mice by androgen and liver X receptor agonist. Cancer Res. 2006 July 1;66(13):6482–6. PMID 16818617</ref> 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.<ref>Gupta S, Hastak K, Ahmad N, Lewin JS, Mukhtar H. Inhibition of prostate carcinogenesis in TRAMP mice by oral infusion of green tea polyphenols. Proc Natl Acad Sci U S A. 2001 August 28;98(18):10350-5. PMID 11504910</ref>
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| ==Epidemiology==
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| 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.<ref>{{cite web | url = http://web.archive.org/web/20060205235509/http://www.jncicancerspectrum.oxfordjournals.org/cgi/statContent/cspectfstat;99 | title = IARC Worldwide Cancer Incidence Statistics—Prostate | publisher = Oxford University Press | work = JNCI Cancer Spectrum | date = December 19, 2001}} Retrieved on 2007-04-05 through the Internet Archive</ref> 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.<ref> [http://www.cancer.org/docroot/CRI/content/CRI_2_2_2X_What_causes_prostate_cancer_36.asp?sitearea= Overview: Prostate Cancer—What Causes Prostate Cancer?] American Cancer Society (2006-05-02). Retrieved on 2007-04-05</ref><ref> [http://www.hsc.stonybrook.edu/som/urology/urology_cp_prostatecancer.cfm Prostate Cancer FAQs.] State University of New York School of Medicine Department of Urology (2006-08-31). Retrieved on 2007-04-05</ref> However, these high rates may be affected by increasing rates of detection.<ref>{{cite journal |author=Potosky A, Miller B, Albertsen P, Kramer B |title=The role of increasing detection in the rising incidence of prostate cancer |journal=[[Journal of the American Medical Association|JAMA]] |volume=273 |issue=7 |pages=548–52 |year=1995 |pmid=7530782 |doi=10.1001/jama.273.7.548}}</ref>
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| 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 United Kingdom it is also the second most common cause of cancer death after lung cancer, where around 35,000 cases are diagnosed every year and of which 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 [[neoplasm]]s of the prostate are, in most cases, slow-growing, and because most of those affected are over 60. 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 (nutrition)|diet]], have been implicated in the development of prostate cancer. The Prostate Cancer Prevention Trial found that [[finasteride]] reduces the incidence of prostate cancer rate by 30%. There had been a controversy about this also increasing the risk of more aggressive cancers, but more recent research showed this was not the case.<ref>{{ cite news | author = Gine Kolata | title = New Take on a Prostate Drug, and a New Debate | url = http://www.nytimes.com/2008/06/15/health/15prostate.html?ei=5087&em=&en=813eaa4e10f57756&ex=1213675200&adxnnl=1&adxnnlx=1213503418-GD4DbGjYsDxqV/xuGWnE1A | publisher = NY Times | date = June 15, 2008 | accessdate = 2008-06-15 }}</ref><ref>{{cite journal |author=Potosky A, Miller B, Albertsen P, Kramer B |title=Finasteride Does Not Increase the Risk of High-Grade Prostate Cancer: A Bias-Adjusted Modeling Approach | url = http://cancerpreventionresearch.aacrjournals.org/cgi/rapidpdf/1940-6207.CAPR-08-0092v1 |journal= Cancer Prevention Research |volume= Published Online First on May 18, 2008 as 10.1158/1940-6207.CAPR-08-0092 |year=2008 |doi=10.1158/1940-6207.CAPR-08-0092 |pages=174 }}</ref>
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| == History ==
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| [[Image:Schally portrait.jpg|right|thumb|150px|'''Andrzej W. Schally''' was awarded the 1977 Nobel Prize in Medicine for his research relating to prostate cancer.]]
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| Although the prostate was first described by Venetian anatomist [[Niccolò Massa]] in 1536, and illustrated by Flemish anatomist [[Vesalius|Andreas Vesalius]] in 1538, prostate cancer was not identified until 1853.<ref>Adams, J. ''The case of scirrhous of the prostate gland with corresponding affliction of the lymphatic glands in the lumbar region and in the pelvis.'' Lancet 1, 393 (1853).</ref> Prostate cancer was initially considered a rare disease, probably because of shorter [[life expectancy|life expectancies]] and poorer detection methods in the 19th century. The first treatments of prostate cancer were surgeries to relieve urinary obstruction.<ref>Lytton, B. ''Prostate cancer: a brief history and the discovery of hormonal ablation treatment.'' J. Urol. 165, 1859–1862</ref> Removal of the entire gland (radical perineal [[prostatectomy]]) was first performed in 1904 by Hugh H. Young at [[Johns Hopkins Hospital]].<ref>Young, H. H. ''Four cases of radical prostatectomy.'' Johns Hopkins Bull. 16, 315 (1905).</ref> 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.<ref>Walsh, P. C., Lepor, H. & Eggleston, J. C. ''Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations.'' Prostate 4, 473-485 (1983). PMID 6889192</ref> This surgical approach allowed for removal of the prostate and lymph nodes with maintenance of penile function.
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| 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]].<ref>Huggins, C. B. & Hodges, C. V. ''Studies on prostate cancer: 1. The effects of castration, of estrogen and androgen injection on serum phosphatases in metastatic carcinoma of the prostate.'' Cancer Res. 1, 203 (1941).</ref> 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.
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| Receptor agonists, such as [[leuprolide]] and [[goserelin]], were subsequently developed and used to treat prostate cancer.<ref>Schally, A. V., Kastin, A. J. & Arimura, A. ''Hypothalamic FSH and LH-regulating hormone. Structure, physiology and clinical studies.'' Fertil. Steril. 22, 703–721 (1971).</ref><ref>Tolis G, Ackman D, Stellos A, Mehta A, Labrie F, Fazekas AT, Comaru-Schally AM, Schally AV. ''Tumor growth inhibition in patients with prostatic carcinoma treated with luteinizing hormone-releasing hormone agonists.'' Proc Natl Acad Sci U S A. 1982 Mar;79(5):1658–62 PMID 6461861</ref>
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| [[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.<ref>Denmeade SR, Isaacs JT. ''A History of Prostate Cancer Treatment.'' Nature Reviews Cancer 2, 389–396 (2002). PMID 12044015</ref> 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.<ref>Scott, W. W. et al. ''Chemotherapy of advanced prostatic carcinoma with cyclophosphamide or 5-fluorouracil: results of first national randomized study.'' J. Urol. 114, 909–911 (1975). PMID 1104900</ref>
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| ==Histopathological Findings in Prostatic Adenocarcinoma==
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| === Prostate: Adenocarcinoma===
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| <youtube v=1SZPLS1dxTo/>
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| == Prostate: Adenocarcinoma (Gleason grading system)==
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| === Prostate: Adenocarcinoma (Gleason grade 1)===
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| <youtube v=F7V0Zl7a2FY/>
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| === Prostate : Adenocarcinoma (Gleason grade 2)===
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| <youtube v=YSOLiSklIXw/>
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| === Prostate : Adenocarcinoma (Gleason grade 3)===
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| <youtube v=TG8vR_pE7yA/>
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| === Prostate: Adenocarcinoma (Gleason grade 4)===
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| <youtube v=R2Cl4HScdGc/>
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| === Prostate: Adenocarcinoma (Gleason grade 5)===
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| <youtube v=F7V0Zl7a2FY/>
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| == See also == | | ==Case Studies== |
| *[[Atypical small acinar proliferation]]
| | [[Prostate cancer case study one|Case #1]] |
| *[[Testosterone]]
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| ==References== | | ==Related Chapters== |
| {{reflist|2}}
| | * [[Atypical small acinar proliferation]] |
| | | * [[Testosterone]] |
| ==External links==
| | * [[Gleason score]] |
| *[http://www.youtube.com/watch?v=gqEOYBNnqb4 Prostate Cancer & Endothelin: PMAP The Proteolysis Map - animation] | |
| *{{dmoz|Health/Conditions_and_Diseases/Cancer/Genitourinary/Prostate/}} | |
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| {{Urogenital neoplasia}} | | {{Urogenital neoplasia}} |
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| [[ru:Рак простаты]]
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| [[simple:Prostate cancer]]
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| [[fi:Eturauhassyöpä]]
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| [[sv:Prostatacancer]]
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| [[tl:Kanser sa prostata]]
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| [[tr:Prostat kanseri]]
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| [[zh:前列腺癌]]
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| [[Category:Disease]] | | [[Category:Disease]] |
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| [[Category:Types of cancer]] | | [[Category:Types of cancer]] |
| [[Category:Oncology]] | | [[Category:Oncology]] |
| [[Category:Mature chapter]] | | |
| | {{WH}} |
| | {{WS}} |
| | [[Category:Urology]] |
| | [[Category:Up-To-Date]] |
| | [[Category:Oncology]] |
| | [[Category:Medicine]] |