Prostate cancer

Prostate cancer, also known as carcinoma of the prostate, is the development of cancer in the prostate, a gland in the male reproductive system.[1] Most prostate cancers are slow growing; however, some grow relatively fast.[2][3] The cancer cells may spread from the prostate to other parts of the body, particularly the bones and lymph nodes.[4] It may initially cause no symptoms.[3] In later stages it can cause difficulty urinating, blood in the urine, or pain in the pelvis, back or when urinating.[5] A disease known as benign prostatic hyperplasia may produce similar symptoms. Other late symptoms may include feeling tired due to low levels of red blood cells.[3]

Factors that increase the risk of prostate cancer include: older age, a family history of the disease, and race. About 99% of cases occur in those over the age of 50. Having a first degree relative with the disease increases the risk 2 to 3 fold. In the United States it is more common in the African American population than the Caucasian population. Other factors that may be involved include a diet high in processed, red meat, or milk products or low in certain vegetables.[2] Prostate cancer is diagnosed by biopsy. Medical imaging may then be done to determine if the cancer has spread to other parts of the body.[5]

Prostate cancer screening is controversial.[2][3] Prostate-specific antigen testing increases cancer detection but does not decrease mortality.[6] The United States Preventive Services Task Force recommends against screening using the PSA testing, due to the risk of over-diagnosis and over-treatment as most cancer diagnosed would remain asymptomatic. The USPSTF concludes that the potential benefits of testing do not outweigh the expected harms.[7] While 5α-reductase inhibitors appear to decrease low grade cancer risk they do not affect high grade cancer risk and thus are not recommended for prevention.[2] Supplementation with vitamins or minerals do not appear to affect the risk.[2][8]

Many cases can be safely followed with active surveillance or watchful waiting. Other treatments may include a combination of surgery, radiation therapy, hormone therapy or chemotherapy.[5] When it only occurs inside the prostate it may be curable.[3] In those in whom the disease has spread to the bones, pain medications, bisphosphonates and targeted therapy, among others may be useful. Outcomes depend on a person's age and other health problems as well as how aggressive and extensive the cancer is. Most people with prostate cancer do not end up dying from the disease.[5] The five year survival rate in the United States is 99%.[9] Globally it is the second most common type of cancer and the fifth leading cause of cancer-related death in men.[10] In 2012 it occurred in 1.1 million men and caused 307,000 deaths.[10] It was the most common cancer in males in 84 countries,[2] occurring more commonly in the developed world. Rates have been increasing in the developing world.[11] Detection increased significantly in the 1980s and 1990s in many areas due to increased PSA testing.[2] Studies of males who died from unrelated causes have found prostate cancer in 30% to 70% of those over age 60.