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Prostate Cancer

Prostate Cancer

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Published by Deepankar Srigyan

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Published by: Deepankar Srigyan on May 15, 2009
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Prostate cancer
Teacher- OlshanskayaEkaterina ViatcheslavovnaСurator- Deepankar Srigyan Group- ML 511
Prostate cancer
Prostate cancer
is adiseasein whichcancer develops in the prostate, a gland in themale reproductive system. It occurs whencellsof the prostatemutateand begin to multiply uncontrollably. These cells maymetastasize(spread) from the prostate to other parts of the body, particularly the  bonesandlymph nodes. Prostate cancer may cause pain, difficulty inurinating, problems during sexual intercourse, erectile dysfunction. Other symptoms can potentially develop during later stages of the disease.Rates of detection of prostate cancers vary widely across the world, with South and East Asia detectingless frequently than in Europe, and especially the United States. Prostate cancer develops mostfrequently in men over the age of fifty and is one of the most prevalent types of cancer in men.However, many men who develop prostate cancer never have symptoms, undergo no therapy, andeventually die of other causes. This is because cancer of the prostate is, in most cases, slow-growing,and because most of those affected are over the age of 60. Hence, they often die of causes unrelated tothe prostate cancer, such as heart/circulatory disease, pneumonia, other unconnected cancers, or old age.Many factors, includinggenetics anddiet, have been implicated in the development of prostate cancer. The presence of prostate cancer may be indicated bysymptoms,  physical examination,  prostate specific antigen(PSA), or  biopsy. There is concern about the accuracy of the PSA test and its usefulness in screening. Suspected prostate cancer is typically confirmed by taking a  biopsyof the prostate and examining it under amicroscope.Further tests, such asCT scansand  bone scans, may be performed to determine whether prostate cancer has spread.Treatment options for prostate cancer with intent to cure are primarily surgery andradiation therapy.  Other treatments such ashormonal therapy, chemotherapy,  proton therapy, cryosurgery,high intensity focused ultrasound(HIFU) also exist depending on the clinical scenario and desired outcome.The age and underlying health of the man, the extent of metastasis, appearance under the microscope,and response of the cancer to initial treatment are important in determining theoutcomeof the disease.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 effectsin terms of patient survival andquality of life.
The prostateis a part of the malereproductive organwhich helps make and storeseminal fluid. In adult men a typical prostate is about three centimeters long and weighs about twenty grams.
It is located in the pelvis, under theurinary bladder and in front of therectum.The prostate surrounds part of theurethra, the tube that carries urinefrom the bladder duringurinationand semen duringejaculation.
Because of itslocation, prostate diseases often affect urination, ejaculation, and rarelydefecation. The prostatecontains many smallglandswhich make about twenty percent of the fluid constitutingsemen.
In prostate cancer the cells of these prostate glandsmutateinto cancer cells. The prostate glands requiremale hormones, known asandrogens, to work properly. Androgens includetestosterone,which is made in thetestes;dehydroepiandrosterone, made in theadrenal glands; anddihydrotestosterone, which is converted from testosterone within the prostate itself. Androgens are also responsible for secondary sexcharacteristicssuch as facial hair and increased muscle mass.
An important part of evaluating prostate cancer is determining thestage, or how far the cancer hasspread. Knowing the stage helps define prognosis and is useful when selecting therapies. The most common system is the four-stage TNMsystem (abbreviated from Tumor/Nodes/Metastases). Its components include the size of the tumor, the number of involvedlymph nodes, and the presence of any
other metastases. The most important distinction made by any staging system is whether or not thecancer is still confined to the prostate. In the TNM system, clinical T1 and T2 cancers are found only inthe prostate, while T3 and T4 cancers have spread elsewhere. Several tests can be used to look for evidence of spread.If cancer is present, the pathologist reports thegradeof 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 Gleasonsystem is used to grade prostate tumors from 2 to 10, where aGleason scoreof 10 indicates the mostabnormalities. The pathologist assigns a number from 1 to 5 for the most common pattern observedunder the microscope, then does the same for the second most common pattern. The sum of these twonumbers is the Gleason score. TheWhitmore-Jewett stageis another method sometimes used. Proper grading of the tumor is critical, since the grade of the tumor is one of the major factors used todetermine the treatment recommendation.
Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for anelevatedPSAnoticed during a routine checkup. Sometimes, however, prostate cancer does causesymptoms, often similar to those of diseases such as benign prostatic hypertrophy. These includefrequent 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 dysfunction as the prostate gland surrounds the prostatic urethra. Changes within the gland therefore directly affecturinary function. Because the vas deferensdeposits seminal fluid into the prostatic urethra, and secretions from the prostate gland itself are included in semen content, prostate cancer may also cause problems with sexual function and performance, such as difficulty achievingerectionor painfulejaculation.Advanced prostate cancer can spread to other parts of the body and this may cause additional symptoms.The most common symptom is bone pain, often in the vertebrae(bones of the spine), pelvisor ribs. Spread of cancer into other bones such as thefemur  is usually to the proximal part of the bone. Prostate cancer in the spinecan also compress thespinal cord, causing leg weakness andurinaryandfecal incontinence.
The specific causes of prostate cancer remain unknown. A man's risk of developing prostate cancer isrelated to hisage,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. However, many men never know they have prostatecancer. 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. 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.
A man's genetic background contributes to his risk of developing prostate cancer. This is suggested byan increasedincidenceof prostate cancer found in certain racial groups, in identicaltwinsof men with  prostate cancer, and in men with certaingenes. In the United States, prostate cancer more commonlyaffects black men than white or Hispanic men, and is also more deadly in black men. Men who have a brother or father with prostate cancer have twice the usual risk of developing prostate cancer.Studies of twinsin Scandinaviasuggest that forty percent of prostate cancer risk can be explained by inherited factors. However, no single gene is responsible for prostate cancer; many different genes have beenimplicated. Two genes (
) that are important risk factors for ovarian cancer and breast cancer in women have also been implicated in prostate cancer.

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