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Prostate Cancer

(Cancer of the Prostate; Prostatic Carcinoma)

Definition

The prostate is a walnut-sized gland in men. It surrounds the urethra. The prostate makes a fluid that is part of semen. Prostate cancer is a disease in which cancer cells grow in the prostate gland.
Prostate Cancer
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The sooner prostate cancer is treated, the better the outcome. Call your doctor right away if you think you have this condition.

Causes

The cause of prostate cancer is unknown.

Risk Factors

Factors that may increase the risk of prostate cancer include:
  • Age: 55 or older
  • Race: Black
  • Family history of prostate cancer, especially father or brother
  • Family history of prostate cancer diagnosed at a young age
  • A high-fat diet

Symptoms

Symptoms may include:
  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Not able to urinate
  • Weak or interrupted urine flow
  • Painful or burning urination
  • Difficulty having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in the lower back, hips, or upper thighs
These symptoms may be caused by other conditions, such as benign prostatic hyperplasia (BPH) or an infection.

Diagnosis

Your doctor will ask about symptoms and medical history. A physical exam will also be done. Your doctor may order tests, such as:

Treatment

Once prostate cancer is found, tests are done to find out if the cancer has spread and, if so, to what extent. Treatment depends on how far the cancer has spread. You will work with a team of specialists to develop a treatment plan for you.
Treatment options include:

Watchful Waiting

This involves your doctor monitoring the cancer to see if it is growing. Watchful waiting may be appropriate if you:
  • Have early stage prostate cancer that is growing slowly
  • Are of an advanced age
  • Have serious health problems (risks of treatment outweigh the benefits)

Surgery

Types of surgery that may be needed include:
Since prostate cancer surgery may cause side effects, like erectile dysfunction, urinary incontinence, and fecal incontinence, there may be other surgery techniques that may be a good option for you. Some examples include nerve-sparing surgery, robotic surgery, and laparoscopic surgery.

Radiation Therapy

Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors. Examples include:
  • Conformal radiation therapy—conformal radiation therapy uses three-dimensional radiation beams that are conformed into the shape of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.
  • Intensity-modulated radiation therapy (IMRT)—IMRT uses radiation beams of different intensities to deliver higher doses of radiation therapy to the tumor and lower doses to nearby tissues at the same time.

Hormone Therapy

If prostate cancer has spread or has returned after being treated, hormone therapy may be used. The goal of hormone therapy is to lower the levels of male hormones, called androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancer to shrink or slow its growth. Examples of hormone therapy include:
  • Luteinizing hormone-releasing hormone (LHRH) analogs (such as goserelin, histrelin, leuprolide, triptorelin)—these drugs cause testosterone to drop to a very low level.
  • Luteinizing hormone-releasing hormone (LHRH) antagonists (such as degarelix)—these also reduce the testosterone level, but do so faster and without the surge of testosterone that happens with the LHRH analogs.
  • Anti-androgens (such as bicalutamide, flutamide, nilutamide)—these drugs work by interfering with the body's ability to use androgens.
  • Other types of hormone therapy, such as:
    • Estrogen therapy—rarely used now unless other treatments are not working
    • Ketoconazole—affects the production of androgens
    • Abiraterone—may be used in cases where prostate cancer does not respond to other treatments
    • Orteronel (experimental drug)—affects the production of androgens
    • Enzalutamide—affects the production of androgens
    • Abiraterone—may be used in advanced stages of prostate cancer
In some case, a type of surgery called orchiectomy may be needed. This involves removing the testicles, which stops androgens from being produced.

Other Treatment Options

Other options may include:
  • Cryosurgery—this involves using an instrument to freeze and destroy prostate cancer cells
  • Chemotherapy—if prostate cancer has spread and other treatments have not been effective, chemotherapy may be used. There are range of chemotherapy drugs available, such as:
    • Docetaxel (this is usually the first chemotherapy drug that is tried)
    • Cabazitaxel
    • Mitoxantrone
    • Estramustine
    • Doxorubicin
  • Immunotherapy—Immunotherapy is a drug treatment that aims to build your immune system so that you can better fight cancer cells. Sipuleucel-T is a type of immunotherapy that is approved to treat prostate cancer that has spread.
  • Targeted therapies—Targeted therapies focus on the cancer cells, rather than attacking both the cancer cells and the healthy cells. Some examples include:
    • Selective endothelin A receptor antagonist (SERA)—interferes with the process that cancer cells go through to grow
    • Anti-angiogenic drugs—blocks the formation of new blood vessels, which stops the growth of the cancer cells
    • Tyrosine kinase inhibitors (such as Imatinib)—blocks the protein that triggers the cancer cells to multiply
  • High-intensity focused ultrasound—This treatment involves using an endorectal probe (a probe that is inserted into the rectum) to destroy cancer cells with ultrasound energy.

Prevention

To reduce your risk of prostate cancer, take the following steps:
  • Eat a healthy diet. Your diet should be high in fruits, vegetables, and fish, and low in red meat.
  • Ask your doctor about taking certain medicines. For example, daily aspirin therapy and 5-alpha reductase inhibitors may reduce your risk of prostate cancer.

RESOURCES

American Cancer Society http://www.cancer.org

National Cancer http://www.pcf.org

CANADIAN RESOURCES

Prostate Cancer Canada http://prostatecancer.ca/

Health Canada http://www.hc-sc.gc.ca

References

Angiogenesis inhibitors. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/angiogenesis-inhibitors. Accessed September 19, 2012.

Biological therapies for cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/biological. Accessed September 19, 2012.

Chemotherapy for prostate cancer. American Cancer Society website. Available at: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-chemotherapy. Updated February 27, 2012. Accessed September 19, 2012.

Evolution of cancer treatments: targeted therapy. American Cancer Society website. Available at: http://www.cancer.org/Cancer/CancerBasics/TheHistoryofCancer/the-history-of-cancer-cancer-treatment-targeted-therapy. Updated June 8, 2012. Accessed September 19, 2012.

FDA approval for sipuleucel-T. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/druginfo/fda-sipuleucel-T. Accessed July 31, 2012.

Hormone (androgen deprivation) therapy for prostate cancer. American Cancer Society website. Available at: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-hormone-therapy. Updated September 4, 1012. Accessed September 19, 2012.

Hormone therapy for prostate cancer. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/hormone-therapy-for-prostate-cancer/MY01633. Updated August 10, 2012. Accessed September 19, 2012.

Imatinib. PubMed Health website. Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000345. Accessed July 31, 2012. Accessed September 19, 2012.

Prostate cancer. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 20, 2012. Accessed September 19, 2012.

Screening for prostate cancer: current recommendation. US Preventative Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm. Published May 2012. Accessed July 31, 2012.

Targeted therapy for prostate cancer. Texas Oncology website. Available at: http://www.texasoncology.com/types-of-cancer/prostate-cancer/targeted-therapy-for-prostate-cancer/. Accessed July 31, 2012.

What is biological therapy? National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/treatment/biologicaltherapy. Accessed September 19, 2012.

What’s new in prostate cancer research and treatment? American Cancer Society website. Available at: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-new-research. Updated September 4, 1012. Accessed September 19, 2012.

What is provenge? Provenge website. Available at: http://www.provenge.com/advanced-prostate-cancer-therapy.aspx. Accessed July 31, 2012.

Xtandi (Enzalutamide) approved for late stage prostate cancer, FDA. Medical News Today website. Available at: http://www.medicalnewstoday.com/articles/249785.php. Accessed September 19, 2012.

2/12/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Smith DP, King MT, Egger S, et al. Quality of life three years after diagnosis of localised prostate cancer: population based cohort study. BMJ. 2009;339:b4817.

2/19/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Mahmud SM, Franco EL, Aprikian AG. Use of non-steroidal anti-inflammatory drugs (NSAIDs) and prostate cancer risk: A meta-analysis. Int J Cancer. 2010 Jan 20.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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