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Prostatic Cancer

Prostatic cancer is the most common neoplasm in men over age 50; it's a leading cause of male cancer death. Adenocarcinoma is the most common form; only seldom does prostatic cancer occur as a sarcoma. Most prostatic cancers originate in the posterior prostate gland, with the rest growing near the urethra. Malignant prostatic tumors seldom result from the benign hyperplastic enlargement that commonly develops around the prostatic urethra in older men.

Slow-growing prostatic cancer seldom produces signs and symptoms until it's well advanced. Typically, when primary prostatic lesions spread beyond the prostate gland, they invade the prostatic capsule and then spread along the ejaculatory ducts in the space between the seminal vesicles or perivesicular fascia. When prostatic cancer is fatal, death usually results from widespread bone metastases.

Causes

Risk factors for prostatic cancer include age (the cancer seldom develops in men under age 40) and infection. Endocrine factors may also have a role, leading researchers to suspect that androgens speed tumor growth.

Signs and Symptoms

Early prostate cancer usually is discovered during a routine digital rectal examination (DRE).

Symptoms are often similar to those of benign prostatic hyperplasia. Men observing the following signs and/or symptoms should see their physician for a thorough examination.

  • Blood in the urine or semen
  • Frequent urination, especially at night
  • Inability to urinate
  • Nagging pain or stiffness in the back, hips, upper thighs, or pelvis
  • Painful ejaculation
  • Pain or burning during urination (dysuria)
  • Weak or interrupted urinary flow

Diagnostic tests 

DRE (recommended yearly by the American Cancer Society for men over age 40) is the standard screening test.

Blood tests may show elevated levels of prostate­specific antigen (PSA). Although most men with metastasized prostatic cancer have an elevated PSA level, the finding also occurs with other prostatic disease. So the PSA level should be assessed in light of DRE findings. Transrectal prostatic ultrasonography may be used for patients with abnormal DRE and PSA test findings.

Bone scan and excretory urography are used to determine the disease's extent. Magnetic resonance imaging and computed tomography scanning can help define the tumor's extent.

Treatment

Therapy varies by cancer stage and may include radiation, prostatectomy, orchiectomy (removal of the testes) to reduce androgen production, and hormonal therapy with synthetic estrogen (diethylstilbestrol). Radical prostatectomy is usually effective for localized lesions without metastasis. A transurethral resection of the prostate may be performed to relieve an obstruction.

Radiation therapy may cure locally invasive lesions in early disease and may relieve bone pain from metastatic skeletal involvement. It also may be used prophylactically for patients with tumors in regional lymph nodes. Alternatively, internal beam radiation may be recommended because it permits increased radiation to reach the prostate but minimizes the surrounding tissues' exposure to radiation.

If hormonal therapy, surgery, and radiation therapy aren't feasible or successful, chemotherapy may be tried. Chemotherapy for prostatic cancer (combinations of cyclophosphamide, doxorubicin, fluorouracil, cisplatin, etoposide, and vindesine) offers limited benefits. Researchers continue to seek the most effective chemotherapeutic regimen.

Prevention

No preventive measures are known. Adopting a vegetarian, low-fat diet or one that mimics the traditional Japanese diet may lower risk. Early identification (as opposed to prevention) is now possible by yearly screening of men over 40 or 50 years old through digital rectal examination (DRE) and PSA blood test.

Two dietary supplements, vitamin E and selenium, may help prevent prostate cancer when taken daily. Estrogens from soybeans and other plant sources (called phytoestrogens ) may also help prevent prostate cancer.



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