Prostate cancer overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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, prostatic sarcoma, and direct invasion of the prostate by rectal adenocarcinoma. 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 risk factors in the development of prostate cancer are family history, African American men, dietary factors, obesity, elevated blood levels of testosterone, Agent Orange exposure, and sexual factors. According to the American Cancer Society (ACS) guidelines, screening for prostate cancer by PSA and DRE is recommended every year 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. Common symptoms of prostate cancer include changes in bladder habits, hematuria, hematospermia, and painful ejaculation. On ultrasound, prostate cancer is characterized by hypoechoic areas. The predominant therapy for prostate cancer is surgical resection. Adjunctive chemotherapy, radiation, hormonal therapy, bisphosphonates, and analgesics may be required. Prognosis of prostate cancer is generally good, and the 5-year survival rate is approximately 98.9%.
Historical Perspective
Prostate cancer was first described in 1536 by Niccolò Massa. In 1983, radical retropubic prostatectomy 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.
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.
Differential Diagnosis
Prostate cancer must be differentiated from benign prostatic hypertrophy, prostatic sarcoma, and direct invasion of the prostate by rectal adenocarcinoma.
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 137.9 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.
Risk Factors
Common risk factors in the development of prostate cancer are family history, African American men, dietary factors, obesity, elevated blood levels of testosterone, Agent Orange exposure, and sexual factors.
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 PSA and DRE is recommended every year 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. According to the American Urological Association (AUA) guidlines, 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.
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.
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.
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 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.
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, 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, healthy weight, and avoiding exposure to Agent Orange.
Secondary Prevention
There are no secondary preventive measures available for prostate cancer.