Prostate cancer Classification and external resources
ICD-10	C61.
ICD-9	185
OMIM	176807
DiseasesDB	10780
MedlinePlus	000380
eMedicine	radio/574
MeSH	D011471

Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled The prostate (from Greek προστάτης - prostates, literally "one who stands before" "protector" "guardian" is a Male (♂ refers to the sex of an organism or part of an organism which produces small mobile Gametes called spermatozoa. The reproductive system is a system of organs within an Organism which work together for the purpose of Reproduction. It occurs when cells of the prostate mutate and begin to multiply out of control. The cell is the structural and functional unit of all known living Organisms It is the smallest unit of an organism that is classified as living and is often called In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms. Urination, also known as micturition, voiding, and more rarely emiction, is the process of disposing Urine from the Urinary bladder A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from

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. ^[1] 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. The American Cancer Society ( ACS) is the "nationwide community-based voluntary health organization dedicated to ^[2][3] However, these high rates may be affected by increasing rates of detection. ^[4]

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. Lung cancer is a Disease of uncontrolled Cell growth in tissues of the Lung. In the UK it is also the second most common cause of cancer death after lung cancer. Around 35,000 men in the UK are diagnosed per year; where 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 neoplasms 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, have been implicated in the development of prostate cancer. Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is This article is primarily about the human diet For a discussion of animal diets see List of feeding behaviours.

Prostate cancer is most often discovered by physical examination or by screening blood tests, such as the PSA (prostate specific antigen) test. Physical examination or clinical examination is the process by which a Health care provider investigates the body of a Patient for signs A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via Prostate specific antigen ( PSA) is a protein produced by the cells of the Prostate gland There is some current concern about the accuracy of the PSA test and its usefulness. Suspected prostate cancer is typically confirmed by removing a piece of the prostate (biopsy) and examining it under a microscope. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues A microscope ( Greek: ( micron) = small + ( skopein) = to look or see is an instrument for viewing objects that are Further tests, such as X-rays and bone scans, may be performed to determine whether prostate cancer has spread. X-radiation (composed of X-rays) is a form of Electromagnetic radiation. Bone imaging is a study to visually detect Bone abnormalities

Prostate cancer can be treated with surgery, radiation therapy, hormonal therapy, occasionally chemotherapy, proton therapy, cryosurgery, or some combination of these. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant Hormonal therapy is one of the major modalities of medical treatment for cancer others being cytotoxic chemotherapy and Targeted therapy (biotherapeutics Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Proton therapy is a type of Particle therapy which utilizes a beam of Protons to irradiate diseased tissue most often in the treatment of cancer The age and underlying health of the man as well as the extent of spread, appearance under the microscope, and response of the cancer to initial treatment are important in determining the outcome of the disease. Since prostate cancer is predominantly a disease of older men, many will die of other causes before a slowly advancing prostate cancer can spread or cause symptoms. This makes treatment selection difficult. ^[5] 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 effects in terms of patient survival and quality of life. The trade-off dilemma in prostate cancer treatment refers to the choice between different treatments for localized Prostate cancer (a tumor that is contained within the prostate

Contents 1 Prostate 2 Symptoms 3 Pathophysiology 4 Etiology 5 Prevention 5.1 Vitamins and medication 5.2 Ejaculation 6 Screening 6.1 Digital rectal examination 6.2 Prostate specific antigen 7 Diagnosis 7.1 Biopsy 7.1.1 Gleason score 7.1.2 Tumor markers 7.2 New tests being investigated 7.2.1 PCA3 7.2.2 Early prostate cancer 7.3 Prostasomes 8 Staging 9 Risk assessment 10 Treatment 10.1 Watchful waiting and active surveillance 10.2 Surgery 10.3 Radiation therapy 10.4 Cryosurgery 10.5 Hormonal therapy 10.6 Palliative care 10.7 High Intensity Focused Ultrasound (HIFU) 11 Prognosis 12 Progression 13 History 14 References 15 See also 16 External links

Prostate

Main article: Prostate

The prostate is a part of the male reproductive organ which helps make and store seminal fluid. The prostate (from Greek προστάτης - prostates, literally "one who stands before" "protector" "guardian" is a The prostate (from Greek προστάτης - prostates, literally "one who stands before" "protector" "guardian" is a The reproductive system is a system of organs within an Organism which work together for the purpose of Reproduction. In Biology, an organ ( Latin: organum, "instrument tool" from Greek όργανον - organon "organ instrument Physiological aspects Internal and external fertilization Depending on the Species, spermatozoa can fertilize In adult men a typical prostate is about three centimeters long and weighs about twenty grams. ^[6] It is located in the pelvis, under the urinary bladder and in front of the rectum. The pelvis (pl pelvises or pelves) or pelvic girdle is the irregular bony structure located at the base of the spine (properly known In Anatomy, the urinary bladder is a hollow muscular, and distensible (or elastic organ that sits on the Pelvic floor in Mammals It is the The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals The prostate surrounds part of the urethra, the tube that carries urine from the bladder during urination and semen during ejaculation. In Anatomy, the urethra (from Greek ουρήθρα - ourethra) is a tube which connects the Urinary bladder to the outside of Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. Urination, also known as micturition, voiding, and more rarely emiction, is the process of disposing Urine from the Urinary bladder Ejaculation is the ejecting of Semen from the Penis, and is usually accompanied by Orgasm. ^[7] Because of its location, prostate diseases often affect urination, ejaculation, and rarely defecation. Defecation is the final act of Digestion by which organisms eliminate solid semisolid or liquid Waste material ( Faeces) from the Digestive tract The prostate contains many small glands which make about twenty percent of the fluid constituting semen. A gland is an organ in an animal's body that synthesizes a substance for release such as Hormones or Breast milk, often into the Bloodstream ^[8] In prostate cancer the cells of these prostate glands mutate into cancer cells. In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism The prostate glands require male hormones, known as androgens, to work properly. Hormones (from Greek ὁρμή - "impetus" are chemicals released by cells that affect cells in other parts of the body Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine Androgens include testosterone, which is made in the testes; dehydroepiandrosterone, made in the adrenal glands; and dihydrotestosterone, which is converted from testosterone within the prostate itself. Testosterone is a Steroid hormone from the Androgen group In mammals testosterone is primarily secreted in the testes of males and the Ovaries The testicle (from Latin testiculus, diminutive of testis, meaning "witness" virility plural testes) is the male Dehydroepiandrosterone ( DHEA) is a natural Steroid Prohormone produced from Cholesterol by the Adrenal glands the Gonads In Mammals the adrenal glands (also known as suprarenal glands) are the triangle-shaped Endocrine glands that sit on top of the Kidneys their Dihydrotestosterone ( DHT) (Full name 5α-Dihydrotestosterone, abbreviating to 5α-DHT; INN: androstanolone; commonly called Androgens are also responsible for secondary sex characteristics such as facial hair and increased muscle mass. Secondary sex characteristics are traits that distinguish the two Sexes of a species but that are not directly part of the Reproductive system.

Symptoms

Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup. Prostate specific antigen ( PSA) is a protein produced by the cells of the Prostate gland Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hypertrophy. Benign prostatic hyperplasia ( BPH) also known as nodular hyperplasia, benign prostatic hypertrophy (technically a misnomer or benign enlargement of These include frequent urination, increased urination at night, difficulty starting and maintaining a steady stream of urine, blood in the urine, and painful urination. In Medicine, polyuria is a condition characterized by the passage of large volumes of urine (at least 2 Nocturia (derived from Latin nox night, and Greek ούρα urine) also called nycturia (Greek νυκτουρία) In Medicine, hematuria (or "haematuria" is the presence of Red blood cells (erythrocytes in the Urine. In Medicine, specifically Urology, dysuria refers to painful Urination. Prostate cancer is associated with urinary disfunction as the prostate gland surrounds the prostatic urethra. Changes within the gland therefore directly affect urinary function. Prostate cancer may also cause problems with sexual function, such as difficulty achieving erection or painful ejaculation. The erection of the Penis, Clitoris or a Nipple is its enlarged and firm state Ejaculation is the ejecting of Semen from the Penis, and is usually accompanied by Orgasm. ^[9] Because the vas deferens deposits seminal fluid into the prostatic urethra, and secretions from the prostate gland itself are included in semen content, prostate cancer can affect sexual performance and cause painful ejaculation. The vas deferens (plural vasa deferentia also called ductus deferens, ( Latin: "carrying-away vessel" is part of the Male Anatomy

Advanced prostate cancer can spread to other parts of the body and this may cause additional symptoms. The most common symptom being bone pain, often in vertebrae (bones of the spine), pelvis or ribs. The term ' Bone pain' (or Ostealgia, or Osteodynia) generally is used to refer to Pain felt within a bone A vertebra (plural vertebrae) is an individual Irregular bone in the spinal or Vertebral column ( aka ischis a flexuous and flexible column The pelvis (pl pelvises or pelves) or pelvic girdle is the irregular bony structure located at the base of the spine (properly known In Vertebrate Anatomy, ribs ( Latin costae) are the long curved Bones which form the ribcage. Spread of Cancer into other bones such as the femur is usually to the proximal part of the bone. The femur is the thigh bone In Humans, it is the longest, most voluminous and strongest Bone. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence. In Human anatomy, the vertebral column ( backbone or spine) is a column of 34 Vertebrae the Sacrum, Intervertebral The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected Urinary incontinence ( UI) is any involuntary leakage of Urine. Fecal incontinence is the loss of regular control of the Bowels. ^[10]

Pathophysiology

Prostate cancer is classified as an adenocarcinoma, or glandular cancer, that begins when normal semen-secreting prostate gland cells mutate into cancer cells. Adenocarcinoma is a cancer that originates in Glandular tissue In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism The region of prostate gland where the adenocarcinoma is most common is the peripheral zone. Initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, a condition known as carcinoma in situ or prostatic intraepithelial neoplasia (PIN). Carcinoma in situ (CIS is an early form of Carcinoma defined by the absence of invasion of surrounding tissues Prostatic intraepithelial neoplasia ( PIN) is a microscopic lesion in the Prostate which is thought to be a precursor to Prostate cancer. Although there is no proof that PIN is a cancer precursor, it is closely associated with cancer. Over time these cancer cells begin to multiply and spread to the surrounding prostate tissue (the stroma) forming a tumor. See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic Eventually, the tumor may grow large enough to invade nearby organs such as the seminal vesicles or the rectum, or the tumor cells may develop the ability to travel in the bloodstream and lymphatic system. The seminal vesicles ( glandulae vesiculosae) are a pair of simple tubular glands posteroinferior to the Urinary bladder of males The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells ��such as nutrients and oxygen—and transports Waste products The lymphatic system in Vertebrates is a network of conduits that carry a clear fluid called Lymph. Prostate cancer is considered a malignant tumor because it is a mass of cells which can invade other parts of the body. Malignant (from the Latin roots mal- = "bad" and -genus = "born" is a medical term used to describe a severe and progressively worsening disease This invasion of other organs is called metastasis. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, Prostate cancer most commonly metastasizes to the bones, lymph nodes, rectum, and bladder. Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system.

Etiology

The specific causes of prostate cancer remain unknown. ^[11] A man's risk of developing prostate cancer is related to his age, genetics, race, diet, lifestyle, medications, and other factors. Ageing or aging (American English is the accumulation of changes in an organism Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is The term race or racial group usually refers to the concept of categorizing Humans into Populations or groups on the basis of various sets This article is primarily about the human diet For a discussion of animal diets see List of feeding behaviours. The term lifestyle was originally coined by Austrian psychologist Alfred Adler in 1929 Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease 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. ^[12] However, many men never know they have prostate cancer. 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. ^[13] 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. ^[14]

A man's genetic background contributes to his risk of developing prostate cancer. This is suggested by an increased incidence of prostate cancer found in certain racial groups, in identical twins of men with prostate cancer, and in men with certain genes. Incidence is a measure of the risk of developing some new condition within a specified period of time Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance In the United States, prostate cancer more commonly affects black men than white or Hispanic men, and is also more deadly in black men. ^[15] Men who have a brother or father with prostate cancer have twice the usual risk of developing prostate cancer. ^[16] Studies of twins in Scandinavia suggest that forty percent of prostate cancer risk can be explained by inherited factors. Twin studies are one of a family of designs in Behavior genetics which aid the study of individual differences by highlighting the role of environmental and genetic Terminology and usage As a cultural term "Scandinavia" has no official definition and is subject to usage by those who identify with the culture in question as well In Genetics, Heritability is the proportion of phenotypic variation in a population that is attributable to genetic variation among individuals ^[17] However, no single gene is responsible for prostate cancer; many different genes have been implicated. Two genes (BRCA1 and BRCA2) that are important risk factors for ovarian cancer and breast cancer in women have also been implicated in prostate cancer. BRCA1 ( Breast cancer 1 early onset is a Human Gene, some mutations of which are associated with a significant increase in the risk of Breast cancer BRCA2 (Breast Cancer Type 2 susceptibility protein is a Human Gene that is involved in the repair of chromosomal Ovarian cancer is a cancerous growth arising from an Ovary. The cancer most commonly forms in the lining of the ovary (resulting in epithelial Breast cancer is a Cancer that starts in the cells of the Breast in women and men ^[18]

Dietary amounts of certain foods, vitamins, and minerals can contribute to prostate cancer risk. Food is any substance usually composed primarily of Carbohydrates Fats water and/or Proteins that can be eaten or drunk by an A vitamin is an Organic compound required as a Nutrient in tiny amounts by an Organism. Dietary minerals are the Chemical elements required by living Organisms other than the four elements Carbon, Hydrogen, Nitrogen, and Men with higher serum levels of the short-chain ω-6 fatty acid linoleic acid have higher rates of prostate cancer. n −6 fatty acids (popularly referred to as ω−6 fatty acids or omega-6 fatty acids) are a family of unsaturated Fatty acids Linoleic acid (LA is an unsaturated Omega-6 fatty acid. It is a colorless liquid However, the same series of studies showed that men with elevated levels of long-chain ω-3 (EPA and DHA) had lowered incidence. Eicosapentaenoic acid (EPA or also icosapentaenoic acid is an Omega-3 fatty acid. Docosahexaenoic acid (commonly known as DHA; 226(ω-3 all-cis -docosa-4710131619-hexa- enoic acid Trivial name cervonic ^[19] A long-term study reports that "blood levels of trans fatty acids, in particular trans fats resulting from the hydrogenation of vegetable oils, are associated with an increased prostate cancer risk. Trans fat is the common name for a type of Unsaturated fat with trans - isomer Fatty acid (s "^[20] Other dietary factors that may increase prostate cancer risk include low intake of vitamin E (Vitamin E is found in green, leafy vegetables), omega-3 fatty acids (found in fatty fishes like salmon), and the mineral selenium. See also Tocopherol, Tocotrienol Vitamin E is the collective name for a set of 8 related Tocopherols and Tocotrienols which are fat-soluble Leaf vegetables, also called potherbs, greens, or leafy greens, are plant leaves eaten as a Vegetable, sometimes accompanied n −3 fatty acids (popularly referred to as ω−3 fatty acids or omega-3 fatty acids) are a family of unsaturated Fatty acids that Salmon is the common name for several species of Fish of the family Salmonidae. Selenium (səˈliniəm is a Chemical element with the Atomic number 34 represented by the chemical symbol Se, an atomic mass of 78 A study in 2007 cast doubt on the effectiveness of lycopene (found in tomatoes) in reducing the risk of prostate cancer. Lycopene is a bright red Carotenoid pigment and Phytochemical found in Tomatoes and other red fruits ^[21] Lower blood levels of vitamin D also may increase the risk of developing prostate cancer. Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells ��such as nutrients and oxygen—and transports Waste products Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or This may be linked to lower exposure to ultraviolet (UV) light, since UV light exposure can increase vitamin D in the body. Ultraviolet ( UV) light is Electromagnetic radiation with a Wavelength shorter than that of Visible light, but longer than X-rays ^[22]

There are also some links between prostate cancer and medications, medical procedures, and medical conditions. Daily use of anti-inflammatory medicines such as aspirin, ibuprofen, or naproxen may decrease prostate cancer risk. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Ibuprofen ( INN) (ˌaɪbjuːˈpɹəʊfɛn (from the now outdated nomenclature i so- bu tyl- pro panoic- phen olic acid is a Non-steroidal Naproxen ( INN) (nəˈprɒksən is a Non-steroidal anti-inflammatory drug (NSAID commonly used for the reduction of moderate to severe Pain, Fever ^[23] Use of the cholesterol-lowering drugs known as the statins may also decrease prostate cancer risk. Hypolipidemic agents, or antihyperlipidemic agents, are a diverse group of pharmaceuticals that are used in the treatment of Hyperlipidemias They are called The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic drugs used to lower Cholesterol levels in people with or at risk of Cardiovascular ^[24] More frequent ejaculation also may decrease a man's risk of prostate cancer. One study showed that men who ejaculated five times a week in their 20s had a decreased rate of prostate cancer, though others have shown no benefit. ^[25][26] Infection or inflammation of the prostate (prostatitis) may increase the chance for prostate cancer. An infection is the detrimental Colonization of a host Organism by a foreign Species. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Prostatitis is an Inflammation of the Prostate gland in men A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits In particular, infection with the sexually transmitted infections chlamydia, gonorrhea, or syphilis seems to increase risk. A sexually transmitted disease ( STD) or venereal disease ( VD) is an illness that has a significant probability of transmission between Humans Gonorrhea (also gonorrhoea) caused by the bacteria Neisseria gonorrhoeae, is a common Sexually transmitted disease. Syphilis is a Sexually transmitted disease caused by the spirochetal Bacterium Treponema pallidum pallidum. ^[27] Finally, obesity^[28] and elevated blood levels of testosterone^[29] may increase the risk for prostate cancer. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Testosterone is a Steroid hormone from the Androgen group In mammals testosterone is primarily secreted in the testes of males and the Ovaries

Research released in May 2007, found that US war veterans who had been exposed to Agent Orange had a 48% increased risk of prostate cancer recurrence following surgery. Agent Orange is the code name for a powerful Herbicide and Defoliant used by the U ^[30]

Prostate cancer risk can be decreased by modifying known risk factors for prostate cancer, such as decreasing intake of animal fat. ^[31]

One research study, by the Cancer Council Victoria, has shown that men who report that they regularly ("more than five times per week") masturbate have up to one third fewer occurrences of prostate cancer. The Cancer Council Australia is a national not for profit organisation which aims to promote Cancer -control policies and to reduce the illness caused by cancer in Masturbation refers to Sexual stimulation especially of one's own genitals ( self masturbation) and often to the point of Orgasm, which ^[32][25] The researchers hypothesize that this could be because regular ejaculation reduces the buildup of carcinogenic deposits such as 3-methylcholanthrene is produced from the breakdown of cholesterol, which could damage the cells lining the prostate. A hypothesis (from Greek) consists either of a suggested explanation for a phenomenon (an event that is observable or of a reasoned proposal suggesting a possible Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled Methylcholanthrene is a highly Carcinogenic Polycyclic aromatic hydrocarbon produced by burning Organic compounds at very high temperatures The researchers also speculated that frequent ejaculation may cause the prostate to mature fully, making it less susceptible to carcinogens. It is also possible that there is another factor (such as hormone levels) that is a common cause of both a reduced susceptibility to prostate cancer and a tendency toward frequent masturbation. Correlation does not imply causation is a phrase used in the Sciences and Statistics to emphasize that Correlation between two variables does not imply There is also some evidence that frequent sexual intercourse is associated with reduced risk of prostate cancer, although contrarily the risks associated with STDs have been shown to increase the risk of prostate cancer. ^[32][25] Once the lining of the prostate is affected with cancer, the only known treatments are surgery and radiation therapy. Both may limit the ability to have erections afterward.

Prevention

Vitamins and medication

Several medications and vitamins may also help prevent prostate cancer. Two dietary supplements, vitamin E and selenium, may help prevent prostate cancer when taken daily. See also Tocopherol, Tocotrienol Vitamin E is the collective name for a set of 8 related Tocopherols and Tocotrienols which are fat-soluble Selenium (səˈliniəm is a Chemical element with the Atomic number 34 represented by the chemical symbol Se, an atomic mass of 78 There is significant research suggesting that diet has a strong influence on a man's chances of getting prostate cancer. ^[33] Estrogens from fermented soybeans and other plant sources (called phytoestrogens) may also help prevent prostate cancer. Phytoestrogens, sometimes called "dietary estrogens" are a diverse group of naturally occurring non steroidal plant compounds that because of their structural similarity with ^[34] The selective estrogen receptor modulator drug toremifene has shown promise in early trials. Selective Estrogen Receptor Modulators ( SERMs) are a class of Medication that acts on the Estrogen receptor. Toremifene citrate is an oral Selective estrogen receptor modulator (SERM which helps oppose the actions of Estrogen in the body ^[35][36] Two medications which block the conversion of testosterone to dihydrotestosterone, finasteride^[37] and dutasteride,^[38] have also shown some promise. Testosterone is a Steroid hormone from the Androgen group In mammals testosterone is primarily secreted in the testes of males and the Ovaries Dihydrotestosterone ( DHT) (Full name 5α-Dihydrotestosterone, abbreviating to 5α-DHT; INN: androstanolone; commonly called Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Dutasteride (marketed as Avodart, Avidart, Avolve, Duagen, Dutas, Dutagen, Duprost) is a 5-alpha-reductase The use of these medications for primary prevention is still in the testing phase, and they are not widely used for this purpose. The problem with these medications is that they may preferentially block the development of lower-grade prostate tumors, leading to a relatively greater chance of higher grade cancers, and negating any overall survival improvement.

Green tea may be protective (due to its polyphenol content), though the data is mixed. Green tea is a type of Tea made solely with the leaves of Camellia sinensis, that has undergone minimal Oxidation during processing Polyphenols are a group of chemical substances found in plants characterized by the presence of more than one Phenol unit or building block per molecule ^[39][40] A 2006 study of green tea derivatives demonstrated promising prostate cancer prevention in patients at high risk for the disease. ^[41] Recent research published in the Journal of the National Cancer Institute suggests that taking multivitamins more than seven times a week can increase the risks of contracting the disease. The National Cancer Institute (NCI is part of the United States Federal government's National Institutes of Health. A multivitamin is a preparation intended to supplement a human diet with Vitamins Dietary minerals and other nutritional elements ^[42][43] This research was unable to highlight the exact vitamins responsible for this increase (almost double), although they suggest that vitamin A, vitamin E and beta-carotene may lie at its heart. It is advised that those taking multivitamins never exceed the stated daily dose on the label. Scientists recommend a healthy, well balanced diet rich in fiber, and to reduce intake of meat. A 2007 study published in the Journal of the National Cancer Institute found that men eating cauliflower, broccoli, or one of the other cruciferous vegetables, more than once a week were 40% less likely to develop prostate cancer than men who rarely ate those vegetables. Cauliflower is one of several vegetables in the species Brassica oleracea, in the family Brassicaceae. Broccoli is a plant of the Cabbage family Brassicaceae (formerly Cruciferae Edible plants in the family Brassicaceae (also called Cruciferae are termed Cruciferous vegetables. ^[44][45] Scientists believe the reason for this phenomenon has to do with a phytochemical called Diindolylmethane in these vegetables that has Anti-Androgenic and immune modulating properties. Phytochemicals are plant-derived chemical compounds under scientific research for their potential health-promoting properties but with unproved benefits 33′-Diindolylmethane or DIM is an Anticarcinogen compound derived from the Digestion of Indole-3-carbinol, found in Brassica An antiandrogen, or androgen antagonist, is any of a group of Hormone Receptor antagonist compounds that are capable of preventing or inhibiting the biologic This compound is currently under investigation by the National Cancer Institute as a natural therapeutic for prostate cancer.

Ejaculation

In 2003, an Australian research team led by Graham Giles of The Cancer Council Australia concluded that frequent masturbation by males appears to help prevent the development of prostate cancer. Masturbation refers to Sexual stimulation especially of one's own genitals ( self masturbation) and often to the point of Orgasm, which ^[32] Australian research concluded that the more men ejaculate between the ages of 20 and 50, the less likely they are to develop prostate cancer. The protective effect is greatest while men are in their twenties: those who had ejaculated more than five times per week in their twenties, for instance, were one-third less likely to develop aggressive prostate cancer later in life. The results contradict those of previous studies, which have suggested that having had many sexual partners, or a high frequency of sexual activity, increases the risk of prostate cancer by up to 40 percent. The key difference is that these earlier studies defined sexual activity as sexual intercourse, whereas the latest study focused on the number of ejaculations, whether or not intercourse was involved. ^[46]

Screening

Main article: Prostate cancer screening

Prostate cancer screening is an attempt to find unsuspected cancers. Prostate cancer screening is an attempt to identify individuals with Prostate cancer in a broad segment of the population&mdashthose for whom there is no reason to suspect prostate Screening, in medicine is a strategy used in a Population to detect a Disease in individuals without signs or Symptoms of that disease Screening tests may lead to more specific follow-up tests such as a biopsy, where small pieces of the prostate are removed for closer study. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues Prostate cancer screening options include the digital rectal exam and the prostate specific antigen (PSA) blood test. A rectal examination or rectal exam is an internal examination of the Rectum such as by a Physician or other healthcare professional Prostate specific antigen ( PSA) is a protein produced by the cells of the Prostate gland Screening for prostate cancer is controversial because it is not clear if the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments.

Prostate cancer is usually a slow-growing cancer, very common among older men. In fact, most prostate cancers never grow to the point where they cause symptoms, and most men with prostate cancer die of other causes before prostate cancer has an impact on their lives. The PSA screening test may detect these small cancers that would never become life threatening. Doing the PSA test in these men may lead to overdiagnosis, including additional testing and treatment. Overdiagnosis is the Diagnosis of "disease" that will never cause Symptoms or death during a Patient 's lifetime Follow-up tests, such as prostate biopsy, may cause pain, bleeding and infection. Prostate Biopsy is a procedure in which small samples are removed from a man's Prostate gland to be tested for the presence of cancer Prostate cancer treatments may cause urinary incontinence and erectile dysfunction. Urinary incontinence ( UI) is any involuntary leakage of Urine. Therefore, it is essential that the risks and benefits of diagnostic procedures and treatment be carefully considered before PSA screening.

No major scientific or medical organizations currently support routine screening for prostate cancer. ^[47]

• In 2002, the U.S. Preventive Services Task Force (USPSTF) concluded that the evidence was insufficient to recommend for or against routine screening for prostate cancer using PSA testing or digital rectal examination (DRE). ^[48] The previous 1995 USPSTF recommendation was against routine screening.
• In 1997, American Cancer Society (ACS) guidelines began recommending that beginning at age 50 (age 45 for African-American men and men with a family history of prostate cancer, and since 2001, age 40 for men with a very strong family history of prostate cancer), PSA testing and DRE be offered annually to men who have a life-expectancy of 10 or more years (average life expectancy is 10 years or more for U. The American Cancer Society ( ACS) is the "nationwide community-based voluntary health organization dedicated to S. men under age 76)^[49] along with information on the risks and benefits of screening. ^[50] The previous ACS recommendations since 1980 had been for routine screening for prostate cancer with DRE annually beginning at age 40, and since 1992 had been for routine screening with DRE and PSA testing annually beginning at age 50. ^[51]
• The 2007 National Comprehensive Cancer Network (NCCN) guideline recommends offering a baseline PSA test and DRE at ages 40 and 45 and annual PSA testing and DRE beginning at age 50 (with annual PSA testing and DRE beginning at age 40 for African-American men, men with a family history of prostate cancer, and men with a PSA ≥ 0. National Comprehensive Cancer Network (NCCN is an alliance of twenty-one cancer centers most of which are designated by the National Cancer Institute (of the National 6 ng/mL at age 40 or PSA > 0. 6 ng/mL at age 45) through age 80, along with information on the risks and benefits of screening. Biopsy is recommended if DRE is positive or PSA ≥ 4 ng/mL, and biopsy considered if PSA > 2. 5 ng/mL or PSA velocity ≥ 0. 35 ng/mL/year when PSA ≤ 2. 5 ng/mL. ^[52]
• Some U. S. radiation oncologists and medical oncologists who specialize in treating prostate cancer recommend obtaining a baseline PSA in all men at age 35^[53] or beginning annual PSA testing in high risk men at age 35. ^[54]

Since there is no firm evidence or general agreement that the benefits of PSA screening outweigh the harms, major scientific and medical organizations recommend that clinicians use a process of shared decision-making that includes discussing with patients the risks of prostate cancer, the potential benefits and harms of screening, and involving the patients in the decision. ^[55]

However, because PSA screening is widespread in the United States, following the recommendations of major scientific and medical organizations to use shared decision-making is legally perilous in some U.S. states. A US state is any one of the fifty subnational entities of the United States of America that share Sovereignty with the federal government ^[56] In 2003, a Virginia jury found a family practice residency program guilty of malpractice and liable for $1 million for following national guidelines and using shared decision-making, thereby allowing a patient (subsequently found to have a high PSA and incurable advanced prostate cancer) to decline a screening PSA test, instead of routinely ordering without discussion PSA tests in all men ≥ 50 years of age as four local physicians testified was their practice, and was accepted by the jury as the local standard of care. The Commonwealth of Virginia ( is an American state A jury a sworn body of persons convened to render a rational, impartial Verdict (a finding of fact on a question officially submitted to them A general practitioner, or GP is a medical practitioner who provides Primary care and specializes in Family medicine. Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a Medical degree ( MD Medical malpractice is professional negligence by act or omission by a Health care provider in which care provided deviates from accepted standards of practice A medical guideline (also called a clinical guideline, clinical protocol or clinical practice guideline) is a document with the aim of guiding decisions For the English law, see Standard of care in English law. In Tort law, the standard of care is the degree of prudence and caution ^[57]

An estimated 20 million PSA tests are done per year in North America and possibly 20 million more outside of North America. ^[58]

• In 2000, 34. 1% of all U. S. men age ≥ 50 had a screening PSA test within the past year and 56. 8% reported ever having a PSA test. ^[55]
• In 2000, 33. 6% of all U. S. men age 50–64 and 51. 3% of men age ≥ 65 had a PSA test within the past year. ^[59]
• In 2005, 33. 5% of all U. S. men age 50–64 had a PSA test in the past year.
  • 37. 5% of men with private health insurance, 20. The term health insurance is generally used to describe a form of Insurance that pays for medical expenses 8% of men with Medicaid insurance, 14. Medicaid is the United States health program for eligible individuals and families with low incomes and resources 0% of currently uninsured men, and 11. Health care in the United States is provided by many separate legal entities 5% of men uninsured for > 12 months. ^[60]
• In 2000–2001, 34. 1% of all Canadian men age ≥ 50 had a screening PSA test within the past year and 47. Country to "Dominion of Canada" or "Canadian Federation" or anything else please read the Talk Page 5% reported ever having a screening PSA test. ^[61]
• Canadian men in Ontario were most likely to have had a PSA test within the past year and men in Alberta were least likely to have had a PSA test with the past year or ever. Ontario (ɒnˈtɛrioʊ is a province located in the central part of Canada, the largest by population and second largest after Quebec Alberta (ælˈbɝtə is one of Canada's prairie provinces. It became a province on September 1 1905 ^[62]

Digital rectal examination

Digital rectal examination (DRE) is a procedure where the examiner inserts a gloved, lubricated finger into the rectum to check the size, shape, and texture of the prostate. A rectal examination or rectal exam is an internal examination of the Rectum such as by a Physician or other healthcare professional Areas which are irregular, hard or lumpy need further evaluation, since they may contain cancer. Although the DRE only evaluates the back of the prostate, 85% of prostate cancers arise in this part of the prostate. Prostate cancer which can be felt on DRE is generally more advanced. ^[63] The use of DRE has never been shown to prevent prostate cancer deaths when used as the only screening test. ^[64]

Prostate specific antigen

Main article: Prostate specific antigen

The PSA test measures the blood level of prostate-specific antigen, an enzyme produced by the prostate. Prostate specific antigen ( PSA) is a protein produced by the cells of the Prostate gland Prostate specific antigen ( PSA) is a protein produced by the cells of the Prostate gland Enzymes are Biomolecules that catalyze ( ie increase the rates of Chemical reactions Almost all enzymes are Proteins Specifically, PSA is a serine protease similar to kallikrein. Serine proteases or serine endopeptidases (newer name are Proteases ( Enzymes that cut Peptide bonds in Proteins in which one of Kallikreins (tissue and plasma kallikrein are peptidases (enzymes that cleave peptide bonds in proteins a subgroup of the Serine protease family Its normal function is to liquify gelatinous semen after ejaculation, allowing spermatozoa to more easily navigate through the uterine cervix. A spermatozoon or spermatozoan ( pl spermatozoa) from the Ancient Greek σπέρμα (seed and ζῷον (living being and more commonly known The cervix (from Latin "neck" is the lower narrow portion of the Uterus where it joins with the top end of the Vagina.

The risk of prostate cancer increases with increasing PSA levels. ^[65] 4 ng/mL was chosen arbitrarily as a decision level for biopsies in the clinical trial upon which the FDA in 1994 based adding prostate cancer detection in men age 50 and over as an approved indication for the first commercially available PSA test. ^[66] 4 ng/mL was used as the biopsy decision level in the PLCO trial, 3 ng/mL was used in the ERSPC and ProtecT trials, and 2. Prostate cancer screening is an attempt to identify individuals with Prostate cancer in a broad segment of the population&mdashthose for whom there is no reason to suspect prostate Prostate cancer screening is an attempt to identify individuals with Prostate cancer in a broad segment of the population&mdashthose for whom there is no reason to suspect prostate Prostate cancer screening is an attempt to identify individuals with Prostate cancer in a broad segment of the population&mdashthose for whom there is no reason to suspect prostate 5 ng/mL is used in the 2007 NCCN guideline.

PSA levels can change for many reasons other than cancer. Two common causes of high PSA levels are enlargement of the prostate (benign prostatic hypertrophy (BPH)) and infection in the prostate (prostatitis). Benign prostatic hyperplasia ( BPH) also known as nodular hyperplasia, benign prostatic hypertrophy (technically a misnomer or benign enlargement of Prostatitis is an Inflammation of the Prostate gland in men A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits It can also be raised for 24 hours after ejaculation and several days after catheterization. PSA levels are lowered in men who use medications used to treat BPH or baldness. Baldness involves the state of lacking hair where it often grows especially on the head These medications, finasteride (marketed as Proscar or Propecia) and dutasteride (marketed as Avodart), may decrease the PSA levels by 50% or more. Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Dutasteride (marketed as Avodart, Avidart, Avolve, Duagen, Dutas, Dutagen, Duprost) is a 5-alpha-reductase

Several other ways of evaluating the PSA have been developed to avoid the shortcomings of simple PSA screening. The use of age-specific reference ranges improves the sensitivity and specificity of the test. The rate of rise of the PSA over time, called the PSA velocity, has been used to evaluate men with PSA levels between 4 and 10 ng/ml, but it has not proven to be an effective screening test. ^[67] Comparing the PSA level with the size of the prostate, as measured by ultrasound or magnetic resonance imaging, has also been studied. This comparison, called PSA density, is both costly and has not proven to be an effective screening test. ^[68] PSA in the blood may either be free or bound to other proteins. Proteins are large Organic compounds made of Amino acids arranged in a linear chain and joined together by Peptide bonds between the Carboxyl Measuring the amount of PSA which is free or bound may provide additional screening information, but questions regarding the usefulness of these measurements limit their widespread use. ^[69][70]

Diagnosis

When a man has symptoms of prostate cancer, or a screening test indicates an increased risk for cancer, more invasive evaluation is offered.

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. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues 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. Endoscopy of the Urinary bladder via the Urethra is called cystoscopy In Anatomy, the urethra (from Greek ουρήθρα - ourethra) is a tube which connects the Urinary bladder to the outside of Transrectal ultrasonography creates a picture of the prostate using sound waves from a probe in the rectum. Transrectal ultrasound uses inaudible Sound waves produced by a probe inserted into the Rectum to create an image of organs in the Pelvis.

Biopsy

Main article: Prostate biopsy

If cancer is suspected, a biopsy is offered. Prostate Biopsy is a procedure in which small samples are removed from a man's Prostate gland to be tested for the presence of cancer During a biopsy a urologist obtains tissue samples from the prostate via the rectum. Urology is the branch of Surgery that focuses on the Urinary tracts of males and females and on the reproductive system of males A biopsy gun inserts and removes special hollow-core needles (usually three to six on each side of the prostate) in less than a second. Prostate biopsies are routinely done on an outpatient basis and rarely require hospitalization. Fifty-five percent of men report discomfort during prostate biopsy. ^[71]

Gleason score

Main article: Gleason score

The tissue samples are then examined under a microscope to determine whether cancer cells are present, and to evaluate the microscopic features (or Gleason score) of any cancer found. A Gleason score is given to Prostate cancer based upon its Microscopic appearance A Gleason score is given to Prostate cancer based upon its Microscopic appearance

Tumor markers

Main article: Tumor markers

Tissue samples can be stained for the presence of PSA and other tumor markers in order to determine the origin of maligant cells that have metastasized. A tumor marker is a substance found in the Blood, Urine, or body tissues that can be elevated in Cancer, among other tissue types ^[72]

New tests being investigated

Currently, an active area of research involves non-invasive methods of prostate tumor detection. Adenoviruses modified to transfect tumor cells with harmless yet distinct genes (such as luciferase) have proven capable of early detection. So far, though, this area of research has only been tested in animal and LNCaP models. LNCap cells are a Cell line of human cells commonly used in the field of Oncology. ^[73]

PCA3

Another potential non-invasive method of early prostate tumor detection is through a molecular test that detects the presence of cell-associated PCA3 mRNA in urine. PCA3 mRNA is expressed almost exclusively by prostate cells and has been shown to be highly over-expressed in prostate cancer cells. PCA3 is not a replacement for PSA but an additional tool to help decide if, in men suspected of having prostate cancer, a biopsy is really needed. The higher the expression of PCA3 in urine, the greater the likelihood of a positive biopsy, i. e. the presence of cancer cells in the prostate. Company Diagnocure has an exclusive worldwide license for all diagnostic and therapeutic applications related to PCA3

Early prostate cancer

It was reported in April 2007 that a new blood test for early prostate cancer antigen-2 (EPCA-2) is being researched that may alert men if they have prostate cancer and how aggressive it will be. Early prostate cancer antigen-2 ( EPCA-2) is a Protein of which blood levels are elevated in Prostate cancer. ^[74][75]

Prostasomes

Epithelial cells of the prostate secrete prostasomes as well as PSA. Prostasomes were discovered in 1978 as submicrometre membranous vesicles (40-500 nm in diameter secreted by the prostate Gland epithelial cells into seminal fluid Prostasomes are membrane –surrounded, prostate-derived organelles that appear extracellularly and one of their physiological functions is to protect the sperm from attacks by the female immune system. Cancerous prostate cells continue to synthesize and secrete prostasomes and may be shielded against immunological attacks by these prostasomes. Research of several aspects of prostasomal involvement in prostate cancer has been performed. ^[76]

Staging

Main article: Prostate cancer staging

An important part of evaluating prostate cancer is determining the stage, or how far the cancer has spread. Prostate cancer staging is the process by which physicians evaluate the spread of Prostate cancer. The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread Knowing the stage helps define prognosis and is useful when selecting therapies. Prognosis (older Greek πρόγνωσις modern Greek πρόγνωση - literally fore-knowing foreseeing) is a medical term denoting the The most common system is the four-stage TNM system (abbreviated from Tumor/Nodes/Metastases). The TNM Classification of Malignant Tumours ( TNM) is a Cancer staging system that describes the extent of Cancer in a patient’s body Its components include the size of the tumor, the number of involved lymph nodes, and the presence of any other metastases. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets,

The most important distinction made by any staging system is whether or not the cancer is still confined to the prostate. In the TNM system, clinical T1 and T2 cancers are found only in the prostate, while T3 and T4 cancers have spread elsewhere. Several tests can be used to look for evidence of spread. These include computed tomography to evaluate spread within the pelvis, bone scans to look for spread to the bones, and endorectal coil magnetic resonance imaging to closely evaluate the prostatic capsule and the seminal vesicles. Computed tomography (CT is a Medical imaging method employing Tomography. Bone imaging is a study to visually detect Bone abnormalities Endorectal coil magnetic resonance imaging or endorectal coil MRI is a type of medical imaging in which MRI is used in conjunction with a coil placed into the rectum The seminal vesicles ( glandulae vesiculosae) are a pair of simple tubular glands posteroinferior to the Urinary bladder of males Bone scans should reveal osteoblastic appearance due to increased bone density in the areas of bone metastisis - opposite to what is found in many other cancers that metastasize.

Computed tomography (CT) and magnetic resonance imaging (MRI) currently do not add any significant information in the assessment of possible lymph node metastases in patients with prostate cancer according to a meta-analysis. Computed tomography (CT is a Medical imaging method employing Tomography. ^[77] The sensitivity of CT was 42% and specificity of CT was 82%. The sensitivity of MRI was 39% and the specificity of MRI was 82%. For patients at similar risk to those in this study (17% had positive pelvic lymph nodes in the CT studies and 30% had positive pelvic lymph nodes in the MRI studies), this leads to a positive predictive value (PPV) of 32. The positive predictive value, or precision rate, or post-test probability of disease, is the proportion of patients with positive test results who are correctly diagnosed 3% with CT, 48. 1% with MRI, and negative predictive value (NPV) of 87. The negative predictive value is the proportion of patients with negative test results who are correctly diagnosed 3% with CT, 75. 8% with MRI.

After a prostate biopsy, a pathologist looks at the samples under a microscope. Pathology (from Greek grc πάθος pathos, "fate harm" and grc -λογία -logia) is the study and If cancer is present, the pathologist reports the grade of the tumor. In Pathology, grading is a measure of the progress of Tumors and other Neoplasms Some pathology grading systems apply only to Malignant neoplasms The grade tells how much the tumor tissue differs from normal prostate tissue and suggests how fast the tumor is likely to grow. The Gleason system is used to grade prostate tumors from 2 to 10, where a Gleason score of 10 indicates the most abnormalities. A Gleason score is given to Prostate cancer based upon its Microscopic appearance The pathologist assigns a number from 1 to 5 for the most common pattern observed under the microscope, then does the same for the second most common pattern. The sum of these two numbers is the Gleason score. The Whitmore-Jewett stage is another method sometimes used. Prostate cancer staging is the process by which physicians evaluate the spread of Prostate cancer. Proper grading of the tumor is critical, since the grade of the tumor is one of the major factors used to determine the treatment recommendation.

Risk assessment

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.

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.

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.

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.

The 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 CaPSURE database.

Treatment

Treatment for prostate cancer may involve watchful waiting, surgery, radiation therapy including brachytherapy and external beam radiation, High Intensity Focused Ultrasound (HIFU), chemotherapy, cryosurgery, hormonal therapy, or some combination. Watchful waiting (also watch and wait or WAW) is an approach to a medical problem in which time is allowed to pass before medical intervention or therapy Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant Brachytherapy (from the Greek brachy, meaning "short" also known as sealed source radiotherapy or endocurietherapy, is a form of HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Cryosurgery (cryotherapy is the application of extreme cold to destroy abnormal or diseased tissue 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 side effects, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations. In Medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as Chemotherapy or Surgery.

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. ^[78] This may enter into the treatment decision.

If the cancer has spread beyond the prostate, treatment options significantly change, so most doctors who treat prostate cancer use a variety of nomograms to predict the probability of spread. This article is about the graphical devices called nomograms For a description of the Japanese puzzle see Nonogram. 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. Cryotherapy is the use of cold in a variety of modalities to treat a medical condition

Watchful waiting and active surveillance

Watchful waiting, also called "active surveillance," refers to observation and regular monitoring without invasive treatment. Watchful waiting (also watch and wait or WAW) is an approach to a medical problem in which time is allowed to pass before medical intervention or therapy Watchful waiting is often used when an early stage, slow-growing prostate cancer is found in an older man. 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 watchful waiting for early stage tumors eventually have signs of tumor progression, and they may need to begin treatment within three years. ^[79] Although men who choose watchful waiting avoid the risks of surgery and radiation, the risk of metastasis (spread of the cancer) may be increased. 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.

Clinically insignificant prostate tumors are often found by accident when a doctor incorrectly orders a biopsy not following the recommended guidelines (abnormal DRE and elevated PSA). The urologist must check that the PSA is not elevated for other reasons, Prostatitis, etc. An annual biopsy is often recommended by a urologist for a patient who has selected watchful waiting when the tumor is clinically insignificant (no abnormal DRE or PSA). The tumors tiny size can be monitored this way and the patient can decide to have surgery only if the tumor enlarges which may take many years or never.

Surgery

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. A prostatectomy is the Surgical removal of all or part of the Prostate gland. The most common type is radical retropubic prostatectomy, when the surgeon removes the prostate through an abdominal incision. Radical retropubic prostatectomy is a surgical procedure in which the Prostate gland is removed through an incision in the Abdomen. 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 perineal prostatectomy is a surgical procedure wherein the Prostate gland is removed through an incision in the area between the Anus and the In Human anatomy, the perineum is generally defined as the surface region in both males and females between the Pubic symphysis and the Coccyx. In some Male Mammals the scrotum - also 'scrutum' or 'scrootum' - is a protuberance of Skin and Muscle containing the Testicles The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. 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.

Radical prostatectomy is effective for tumors which have not spread beyond the prostate;^[80] cure rates depend on risk factors such as PSA level and Gleason grade. A prostatectomy is the Surgical removal of all or part of the Prostate gland. However, it may cause nerve damage that significantly alters the quality of life of the prostate cancer survivor. A nerve is an enclosed cable-like bundle of peripheral Axons (the long slender projections of Neurons.

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.

Laparoscopic radical prostatectomy, LRP, is the more modern form of the historical open radical retropubic prostatectomy. 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 and a departure from what historically required the application of relatively primitive surgical techniques. Laparoscopic radical prostatectomy is not a new prostate cancer treatment. Rather, laparoscopic radical prostatectomy is a modern means of performing prostate cancer surgery, the oldest treatment for prostate cancer.

The LRP technical manual was published in 1999 by Drs. Bertrand Guillonneau, Arnon Krongrad, and Guy Vallancien. LRP is laparoscopic prostate surgery, not laser prostate surgery.

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. Radical retropubic prostatectomy is a surgical procedure in which the Prostate gland is removed through an incision in the Abdomen. ^[77] The relative risk reduction was 57. The relative risk reduction is a measure used in Epidemiology. 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. In Epidemiology, the absolute risk reduction is the decrease in Risk of a given activity or treatment in relation to a control activity or treatment 5%. 4. 9 patients must be treated for one to benefit (number needed to treat = 4. The number needed to treat (NNT is an epidemiological measure used in assessing the effectiveness of a health-care intervention typically a treatment with Medication 9).

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. Transurethral resection of the prostate (also known as TURP, plural TURPs and as a transurethral prostatic resection TUPR) is a urological operation In Anatomy, the urethra (from Greek ουρήθρα - ourethra) is a tube which connects the Urinary bladder to the outside of TURP is generally for benign disease and is not meant as definitive treatment for prostate cancer. During a TURP, a small tube (cystoscope) is placed into the penis and the blocking prostate is cut away. Endoscopy of the Urinary bladder via the Urethra is called cystoscopy

In metastatic disease, where cancer has spread beyond the prostate, removal of the testicles (called orchiectomy) may be done to decrease testosterone levels and control cancer growth. The testicle (from Latin testiculus, diminutive of testis, meaning "witness" virility plural testes) is the male Castration (also referred to as Gelding, Neutering, Fixing, orchiectomy, and orchidectomy is any action surgical, chemical (See hormonal therapy, below).

The most common serious complications of surgery are loss of urinary control and impotence. Urinary incontinence ( UI) is any involuntary leakage of Urine. 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. An orgasm (sexual climax is the conclusion of the plateau phase of the sexual response cycle, and may be experienced by both males and females Medications such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) may restore some degree of potency. Sildenafil citrate, sold as Viagra, Revatio and under various other trade names is a drug used to treat Erectile dysfunction (male impotence Tadalafil is an orally administered drug for treating impotence ( Erectile dysfunction) that initially was developed by the Biotechnology company ICOS Vardenafil ( INN) is a PDE5 inhibitor used for treating impotence ( Erectile dysfunction) that is sold under the trade name Levitra ( Bayer For most men with organ-confined disease, a more limited "nerve-sparing" technique may help reduce urinary incontinence and impotence. ^[81]

Radiation therapy

Radiation therapy, also known as radiotherapy, is often used to treat all stages of prostate cancer, or when surgery fails. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant Radiotherapy uses ionizing radiation to kill prostate cancer cells. Image talkNew_radiation_symbol_ISO_21482svg for details --> Ionizing radiation 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). Image talkNew_radiation_symbol_ISO_21482svg for details --> Ionizing radiation Deoxyribonucleic acid ( DNA) is a Nucleic acid that contains the genetic instructions used in the development and functioning of all known Two different kinds of radiation therapy are used in prostate cancer treatment: external beam radiation therapy and brachytherapy. External beam radiotherapy otherwise known as teletherapy, is the most frequently used form of Radiotherapy. Brachytherapy (from the Greek brachy, meaning "short" also known as sealed source radiotherapy or endocurietherapy, is a form of

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. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant 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 then traditional treatment, one of these is Tomotherapy. TomoTherapy, or Helical TomoTherapy is a form of CT Guided IMRT or Intensity Modulated Radiation Therapy, which is a relatively new type of Radiation therapy delivery

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^[82] 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. Iodine-125 (125I is a Radioisotope of Iodine which has uses in Biological assays and in Radiation therapy to treat Prostate cancer Palladium-103 is a Radioisotope of the element Palladium which has uses in Radiation therapy for Prostate cancer and Uveal melanoma In Human anatomy, the perineum is generally defined as the surface region in both males and females between the Pubic symphysis and the Coccyx. These seeds emit lower-energy X-rays which are only able to travel a short distance. Superficial X-rays are low energy X-rays that do not penetrate very far before they are absorbed 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. ^[83]

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. ^[84] Others use a "triple modality" combination of external beam radiation therapy, brachytherapy, and hormonal therapy.

Radiation therapy uses high-energy rays or particles to kill cancer cells. ^[85] When delivered in the correct dosage, radiation can reduce the risk of recurrence.

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.

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. Absorbed dose (also known as total ionizing dose, TID is a measure of the energy deposited in a medium by Ionizing radiation.

Side effects of radiation therapy might occur after a few weeks into treatment. Both types of radiation therapy may cause diarrhea and mild rectal bleeding due to radiation proctitis, as well as urinary incontinence and impotence. In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea Gastrointestinal bleeding or gastrointestinal hemorrhage describes every form of Hemorrhage (loss of Blood) in the Gastrointestinal tract Radiation proctitis (and the related radiation colitis) is Inflammation and damage to the lower parts of the colon after exposure to X-rays or 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. ^[86] Men who have undergone external beam radiation therapy may have a slightly higher risk of later developing colon cancer and bladder cancer. Colorectal cancer, also called colon cancer or large bowel cancer, includes Cancerous growths in the colon, Rectum and Bladder cancer refers to any of several types of malignant growths of the Urinary bladder. ^[87]

Cryosurgery

Cryosurgery is another method of treating prostate cancer in which the prostate gland is exposed to freezing temperatures^[88]. Cryosurgery (cryotherapy is the application of extreme cold to destroy abnormal or diseased tissue It is less invasive than radical prostatectomy, and general anesthesia is less commonly used. In modern medical practice general anaesthesia ( AmE: anesthesia) is a state of total unconsciousness resulting from General anaesthetic drugs Under ultrasound guidance, a method invented by Dr. Gary Onik,^[89] metal rods are inserted through the skin of the perineum into the prostate. Gary Onik is the inventor of Ultrasound guided Cryosurgery for both the Prostate and the Liver. In Human anatomy, the perineum is generally defined as the surface region in both males and females between the Pubic symphysis and the Coccyx. Highly purified Argon gas is used to cool the rods, freezing the surrounding tissue at −196 °C (−320 °F). The Celsius Temperature scale was previously known as the centigrade scale. Fahrenheit is a temperature scale named after Daniel Gabriel Fahrenheit (1686–1736 a German Physicist who proposed it in 1724 As the water within the prostate cells freeze, the cells die. The urethra is protected from freezing by a catheter filled with warm liquid. In Anatomy, the urethra (from Greek ουρήθρα - ourethra) is a tube which connects the Urinary bladder to the outside of Foley Catheters are flexible (usually Latex) tubes that are passed through the Urethra during Urinary catheterization and into the bladder 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^[90] Cryosurgery has also been demonstrated to be superior to radical prostatectomy for recurrent cancer following radiation therapy.

Hormonal therapy

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. Hormonal therapy is one of the major modalities of medical treatment for cancer others being cytotoxic chemotherapy and Targeted therapy (biotherapeutics Dihydrotestosterone ( DHT) (Full name 5α-Dihydrotestosterone, abbreviating to 5α-DHT; INN: androstanolone; commonly called 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. ^[91]

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. Feedback is a circular causal Process whereby some proportion of a system's output is returned (fed back to the Input. First, low blood levels of DHT stimulate the hypothalamus to produce gonadotropin releasing hormone (GnRH). The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis Gonadotropin-releasing hormone ( GNRH) also known as Luteinizing-hormone releasing hormone ( LHRH) is a tropic Peptide Hormone GnRH then stimulates the pituitary gland to produce luteinizing hormone (LH), and LH stimulates the testicles to produce testosterone. The pituitary gland, or hypophysis, is an Endocrine gland about the size of a Pea. Luteinizing hormone ( LH, also known as lutropin) is a Hormone produced by the Anterior pituitary gland. The testicle (from Latin testiculus, diminutive of testis, meaning "witness" virility plural testes) is the male Finally, testosterone from the testicles and dehydroepiandrosterone from the adrenal glands stimulate the prostate to produce more DHT. In Mammals the adrenal glands (also known as suprarenal glands) are the triangle-shaped Endocrine glands that sit on top of the Kidneys their Hormonal therapy can decrease levels of DHT by interrupting this pathway at any point.

There are several forms of hormonal therapy:

• Orchiectomy is surgery to remove the testicles. Castration (also referred to as Gelding, Neutering, Fixing, orchiectomy, and orchidectomy is any action surgical, chemical 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.
• Antiandrogens are medications such as flutamide, bicalutamide, nilutamide, and cyproterone acetate which directly block the actions of testosterone and DHT within prostate cancer cells. An antiandrogen, or androgen antagonist, is any of a group of Hormone Receptor antagonist compounds that are capable of preventing or inhibiting the biologic Flutamide is an oral Antiandrogen drug primarily used to treat Prostate cancer. Bicalutamide (marketed as Casodex, Nilutamide is an Antiandrogen medication used in the treatment of advanced stage Prostate cancer. Cyproterone acetate ( Androcur, Cyprostat, Cyproteron, Procur, Cyprone, Cyprohexal, Ciproterona, Cyproteronum
• Medications which block the production of adrenal androgens such as DHEA include ketoconazole and aminoglutethimide. Ketoconazole is a synthetic Antifungal drug used to prevent and treat skin and fungal infections especially in immunocompromised patients such as those Aminoglutethimide is an anti- Steroid drug marketed under the tradename Cytadren by Novartis around the world 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.
• GnRH action can be interrupted in one of two ways. GnRH antagonists suppress the production of LH directly, while GnRH agonists suppress LH through the process of downregulation after an initial stimulation effect. A gonadotropin-releasing hormone analogue, also known as a GnRH analogue, (sometimes analog) is a synthetic Peptide drug modeled after the A gonadotropin-releasing hormone analogue, also known as a GnRH analogue, (sometimes analog) is a synthetic Peptide drug modeled after the WikipediaWikipedia is not a dictionary ---> Downregulation is the process by which Abarelix is an example of a GnRH antagonist, while the GnRH agonists include leuprolide, goserelin, triptorelin, and buserelin. Abarelix is an injectable Gonadotropin-releasing hormone antagonist ( GnRH antagonist) Leuprorelin ( INN) or leuprolide acetate ( USAN) is a Gonadotropin-releasing hormone agonist ( GnRH agonist) Goserelin Acetate is an injectable Gonadotropin releasing hormone super-agonist ( GnRH agonist) also known as an LHRH agonist Triptorelin (acetate or pamoate is a Gonadotropin-releasing hormone agonist (GnRH agonist It is normally delivered via a nasal spray but is also available as an injection 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. ^[92]

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.

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 flashes, weight gain, loss of libido, enlargement of the breasts (gynecomastia), impotence and osteoporosis. Hot flashes (also known as hot flushes or night sweats if they happen at night are a symptom of the changing Hormone levels that are considered to be Libido in its common usage means Sexual desire however more technical definitions such as those found in the work of Carl Jung, are more general referring to libido The breast is the upper Ventral region of an animal’s Torso, particularly that of Mammals including Human beings. Gynecomastia, or gynaecomastia, ˌgaɪnəkoʊˈmæstiə is the development of abnormally large Mammary glands in Males resulting in breast enlargement which Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. 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 blood clots. Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Thrombosis is the formation of a blood Clot ( Thrombus) inside a Blood vessel, obstructing the flow of Blood through the Circulatory The antiandrogens do not generally cause impotence and usually cause less loss of bone and muscle mass. Ketoconazole can cause liver damage with prolonged use, and aminoglutethimide can cause skin rashes. Drug metabolism in liver The human body identifies almost all drugs as foreign substances (i A rash is a change of the Skin which affects its color appearance or Texture.

Palliative care

Palliative care for advanced stage prostate cancer focuses on extending life and relieving the symptoms of metastatic disease. Palliative care (from Latin palliare to cloak is any form of medical care or treatment that concentrates on reducing the severity of Disease Symptoms Chemotherapy may be offered to slow disease progression and postpone symptoms. Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. The most commonly used regimen combines the chemotherapeutic drug docetaxel with a corticosteroid such as prednisone. Docetaxel is a clinically well established anti-mitotic Chemotherapy Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. Prednisone is a synthetic Corticosteroid drug that is usually taken orally but can be delivered by Intramuscular injection and can be used for a great number ^[93] Bisphosphonates such as zoledronic acid have been shown to delay skeletal complications such as fractures or the need for radiation therapy in patients with hormone-refractory metastatic prostate cancer. In Pharmacology, bisphosphonates (also called diphosphonates) are a class of drugs that inhibit Osteoclast action and the resorption of bone A fracture is the (local separation of an object or material into two or more pieces under the action of stress. ^[94]

Bone pain due to metastatic disease is treated with opioid pain relievers such as morphine and oxycodone. The term ' Bone pain' (or Ostealgia, or Osteodynia) generally is used to refer to Pain felt within a bone An opioid is a chemical Substance that has a Morphine -like action in the body Medical uses Morphine can be used as an analgesic in hospital settings to relieve pain in Myocardial infarction pain in Oxycodone is an Opioid Analgesic Medication synthesized from Thebaine. External beam radiation therapy directed at bone metastases may provide pain relief. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm Injections of certain radioisotopes, such as strontium-89, phosphorus-32, or samarium-153, also target bone metastases and may help relieve pain. A radionuclide is an Atom with an unstable nucleus, which is a nucleus characterized by excess energy which is available to be imparted either to a newly-created The Alkali earth metal Strontium ( Sr) has four stable naturally occurring Isotopes 84Sr (0 Although Phosphorus ( P) has multiple Isotopes, only one of these isotopes is stable 31P as such it is considered a monoisotopic element Samarium-153-ethylene diamine tetramethylene phosphonate, Samarium-153 EDTMP, Quadramet, or simply Samarium-153 is a complex of a Radioisotope

High Intensity Focused Ultrasound (HIFU)

HIFU for prostate cancer utilizes high intensity focused ultrasound (HIFU) to ablate/destroy the tissue of the prostate. HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound During the HIFU procedure, sound waves are used to heat the prostate tissue thus destroying the cancerous cells. HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound 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 100oC. ^[95] 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. HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound The ability to focus the ultrasonic waves leads to a relatively low occurrence of both incontinence and impotence. (0. 6% and 0-20%, respectively)^[96] According to international studies, when compared to other procedures, HIFU has a high success rate with a reduced risk of side effects. HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound Studies using the Sonablate 500 HIFU machine have shown that 94% of patients with a pretreatment PSA (Prostate Specific Antigen) of less than 10 g/ml were cancer-free after three years. HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound Prostate specific antigen ( PSA) is a protein produced by the cells of the Prostate gland ^[97] However, many studies of HIFU were performed by manufacturers of HIFU devices, or members of manufacturers' advisory panels. ^[98]

HIFU was first used in the 1940’s and 1950’s in efforts to destroy tumors in the central nervous system. HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound Since then, HIFU has been shown to be effective at destroying malignant tissue in the brain, prostate, spleen, liver, kidney, breast, and bone. HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound ^[99] Today, the HIFU procedure for prostate cancer is performed using a transrectal probe. HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound 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.

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. HIFU ( high intensity focused ultrasound) (sometimes FUS or HIFUS) is a highly precise medical procedure using high-intensity focused Ultrasound 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.

Prognosis

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. The term developed country, or advanced country, is used to categorize countries with developed Economies in which the tertiary and quaternary sectors It's not currently known whether or not both of this factors, or just one of them, contributes to the occurrence of prostate cancer). ^[100] 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. ^[101] In Japan, death from prostate cancer was one-fifth to one-half the rates in the United States and Europe in the 1990s. For a topic outline on this subject see List of basic Japan topics. ^[102] In India in the 1990s, half of the people with prostate cancer confined to the prostate died within ten years. India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country ^[103] African-American men have 50–60 times more prostate cancer and prostate cancer deaths than men in Shanghai, China. Shanghai ( 上[[wikt 海|海]] is the largest city in China in terms of population and one of the largest urban areas in the world with over 20 million China ( Wade-Giles ( Mandarin) Chung¹kuo² is a cultural region, an ancient Civilization, and depending on perspective a National ^[104] In Nigeria, two percent of men develop prostate cancer and 64% of them are dead after two years. Nigeria, officially named the Federal Republic of Nigeria, is a federal Constitutional republic comprising thirty-six states and one Federal ^[105]

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. Nomograms can be used to calculate the estimated risk of the individual patient. This article is about the graphical devices called nomograms For a description of the Japanese puzzle see Nonogram. The predictions are based on the experience of large groups of patients suffering from cancers at various stages. ^[106]

Progression

In 1941, Charles Huggins reported that androgen ablation therapy causes regression of primary and metastatic androgen-dependent prostate cancer. Charles Brenton Huggins ( September 22, 1901 &ndash January 12, 1997) was a Canadian-born American physician and physiologist and cancer researcher Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine ^[107] However, it is now known that 80–90% of prostate cancer patients develop androgen-independent tumors 12–33 months after androgen ablation therapy, leading to a median overall survival of 23–37 months from the time of initiation of androgen ablation therapy. Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine ^[108] The actual mechanism contributes to the progression of prostate cancer is not clear and may vary between individual patient. A few possible mechanisms have be proposed. ^[109] 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. The androgen receptor ( AR) also known as NR3C4 (nuclear receptor subfamily 3 group C member 4 is a type of Nuclear receptor which is activated by AR, an androgen-activated transcription factor, belongs to the steroid nuclear receptor family. In the field of Molecular biology, a transcription factor (sometimes called a sequence-specific DNA binding factor is a Protein that binds to specific sequences In the field of Molecular biology, nuclear receptors are a class of Proteins found within the interior of cells that are responsible for sensing the presence of 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. Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine Elevation of AR expression is often observed in advanced prostate tumors in patients. See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic ^[110][111] 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 is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine Prostate specific antigen ( PSA) is a protein produced by the cells of the Prostate gland Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine Androgens paradoxically inhibit the proliferation of these androgen-independent prostate cancer cells. Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled ^{[112][113][114]} 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. Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine In vivo ( Latin: within the living means that which takes place inside an organism. Androgen is the generic term for any natural or synthetic compound usually a Steroid Hormone, that stimulates or controls the development and maintenance of masculine ^[115][116] 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. Green tea is a type of Tea made solely with the leaves of Camellia sinensis, that has undergone minimal Oxidation during processing Polyphenols are a group of chemical substances found in plants characterized by the presence of more than one Phenol unit or building block per molecule Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, ^[117]

History

Although the prostate was first described by Venetian anatomist Niccolò Massa in 1536, and illustrated by Flemish anatomist Andreas Vesalius in 1538, prostate cancer was not identified until 1853. Venice ( Italian: Venezia, Venetian: Venesia or Venexia) is a city in Northern Italy, the capital of the Niccolò Massa (1485–1569 was an Italian Anatomist who wrote an early anatomy text Anatomiae Libri Introductorius in 1536 Flanders (Vlaanderen Flandre Flandern is a geographical region located in parts of present day Belgium, France, and the Netherlands. Andreas Vesalius ( Brussels, December 31, 1514 - Zakynthos, October 15, 1564) was an anatomist, Physician ^[118] Prostate cancer was initially considered a rare disease, probably because of shorter life expectancies and poorer detection methods in the 19th century. Life expectancy is the average number of years of life remaining at a given age The first treatments of prostate cancer were surgeries to relieve urinary obstruction. ^[119] Removal of the entire gland (radical perineal prostatectomy) was first performed in 1904 by Hugh H. Young at Johns Hopkins Hospital. A prostatectomy is the Surgical removal of all or part of the Prostate gland. Hugh Hampton Young MD ( 18 September 1870 – 23 August 1945) was an American surgeon, Urologist, and Medical Johns Hopkins University|Johns Hopkins University School of Medicine|Greenspring StationThe Johns Hopkins Hospital is a Teaching hospital in Baltimore Maryland ^[120] Surgical removal of the testes (orchiectomy) to treat prostate cancer was first performed in the 1890s, but with limited success. Castration (also referred to as Gelding, Neutering, Fixing, orchiectomy, and orchidectomy is any action surgical, chemical 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. Transurethral resection of the prostate (also known as TURP, plural TURPs and as a transurethral prostatic resection TUPR) is a urological operation Radical retropubic prostatectomy was developed in 1983 by Patrick Walsh. ^[121] This surgical approach allowed for removal of the prostate and lymph nodes with maintenance of penile function.

In 1941 Charles B. Huggins published studies in which he used estrogen to oppose testosterone production in men with metastatic prostate cancer. Charles Brenton Huggins ( September 22, 1901 &ndash January 12, 1997) was a Canadian-born American physician and physiologist and cancer researcher Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, This discovery of "chemical castration" won Huggins the 1966 Nobel Prize in Physiology or Medicine. Castration (also referred to as Gelding, Neutering, Fixing, orchiectomy, and orchidectomy is any action surgical, chemical The Nobel Prize in Physiology or Medicine (Nobelpriset i fysiologi eller medicin is awarded once a year by the Swedish Karolinska Institute. ^[122] 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. Gonadotropin-releasing hormone ( GNRH) also known as Luteinizing-hormone releasing hormone ( LHRH) is a tropic Peptide Hormone Andrzej Viktor Schally (born November 30, 1926) is an Polish Endocrinologist and Nobel Prize laureate (1977 in medicine Roger Charles Louis Guillemin (born January 11, 1924 in Dijon, Bourgogne France received the National Medal of Science in 1976 and Nobel Receptor agonists, such as leuprolide and goserelin, were subsequently developed and used to treat prostate cancer. Leuprorelin ( INN) or leuprolide acetate ( USAN) is a Gonadotropin-releasing hormone agonist ( GnRH agonist) Goserelin Acetate is an injectable Gonadotropin releasing hormone super-agonist ( GnRH agonist) also known as an LHRH agonist ^[123][124]

Radiation therapy for prostate cancer was first developed in the early 20th century and initially consisted of intraprostatic radium implants. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant Radium (ˈreɪdiəm is a radioactive Chemical element which has the symbol Ra and Atomic number 88 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. ^[125] 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. Cyclophosphamide (the generic name for Cytoxan Neosar Revimmune also known as cytophosphane is a Nitrogen mustard alkylating agent, from the oxazophorines group Fluorouracil (5-FU or f5U is a Pyrimidine analog, which is used as a drug in the treatment of Cancer. ^[126]

References

See also

• Testosterone

External links

• Prostate cancer at the Open Directory Project
• Prostate Cancer Research Foundation of Canada
• Malecare Prostate Cancer Support
• Prostate Cancer Foundation
• National Institute on Aging Information Center
• National Prostate Cancer Coalition (NPCC)
• PROCURE: Prostate cancer. The healing begins with awareness.
• Prostate Cancer Treatment Information
• A massive aggregation of media articles and data collated by patients for patients & Forum for patients and carers
• PCA3: Helping you decide when prostate biopsy is right

Testosterone is a Steroid hormone from the Androgen group In mammals testosterone is primarily secreted in the testes of males and the Ovaries The Open Directory Project ( ODP) also known as dmoz (from directory

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