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Understanding Prostate Cancer

Last Updated May 30, 2019

While the odds are good that you know someone who has been affected by prostate cancer, you may not know all the facts. Learn the hereditary factors, treatment methods, and some possible preventive measures.

WHAT IS PROSTATE CANCER?
The prostate gland is found only in men. It is located below the bladder and in front of the rectum. The urethra, a tube that carries urine, goes through the middle of the prostate. The function of the prostate is to produce semen, which provides nutrition and protection to sperm.

WHAT ARE THE TYPES OF PROSTATE CANCER?
Most prostate cancers (90%) are acinar adenocarcinoma. Adenocarcinoma describes the location of the cancer- within the gland cells that line the prostate.  Acinar describes the way the cancer cells appear under the microscope. There are also other types of adenocarcinoma, including atrophic, foamy, colloid and signet ring carcinoma. The other 10% of prostate cancers include ductal adenocarcinoma, transitional cell (or urothelial) cancer, squamous cell cancer, carcinoid, small cell cancer, and sarcomas/sarcomatoid cancers.

HOW PREVALENT IS PROSTATE CANCER? WHO IS AFFECTED?
Prostate cancer is the second most common cancer in men, behind skin cancer. It is also the second leading cause of cancer death in American men, behind lung cancer. The American Cancer Society’s estimates for prostate cancer in 2019 in the United States are approximately 174,650 new cases and 31,620 deaths from prostate cancer. One in 9 men are diagnosed with prostate cancer and 1 in 41 men will die of prostate cancer. The risk for prostate cancer increases with age. Prostate cancer is rare before age 40. 6 in 10 cases occur at age 65 or older, with an average age of diagnosis at age 66.  Almost 3 million US men are prostate cancer survivors.

New stats: https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

WHAT CAUSES PROSTATE CANCER?
The exact cause of prostate cancer is unknown. What we do know is that mutations can occur in the DNA within prostate cancer cells, and these mutations can cause prostate cancer. Most of these mutations are somatic, meaning people are not born with them and that they are found only in the tumor tissue, not in other cells of the body. Other mutations, called germline mutations, are hereditary and are often inherited from parents. Genes that can contain mutations linked with hereditary prostate cancer include ATM, BRCA1, BRCA2, CHEK2, EPCAM, mismatch repair genes (MLH1, MSH2 MSH6, PMS2) HOXB13, NBN, and TP53. Links with other genes are being studied.

http://www.cancernetwork.com/asco-prostate-cancer/current-guidelines-miss-relevant-germline-mutations-prostate-cancer

CAN MEN PREVENT PROSTATE CANCER OR LOWER THEIR RISK?
Because the cause of most prostate cancers is unknown, many cases of prostate cancer cannot be prevented. However, there are a few preventive measures that men can exercise to possibly lower their risk. These include: maintaining a healthy weight, exercising, and eating at least 2½ cups of a wide variety of vegetables and fruits daily. Some studies support taking minerals and vitamins for risk reduction, and others support taking medications such as 5-alpha reductase inhibitors, including Finasteride (Proscar®) and Dutasteride (Avodart®), or aspirin.

HOW DO MEN GET DIAGNOSED?
Most prostate cancers are diagnosed after a screening test, such as a prostate-specific antigen (PSA) blood test and/or a digital rectal exam (DRE), point doctors to investigate further. Imaging tests such as transrectal ultrasound (TRUS) and MRIs can also help.  A diagnosis is usually confirmed after needle biopsies of areas of the prostate that appear worrisome and analysis of the biopsied sample under the microscope.

WHAT ARE THE TREATMENT OPTIONS FOR PROSTATE CANCER?
Treatment options include expectant management (watchful waiting) or active surveillance, surgery, radiation therapy, cryosurgery (cryotherapy), hormone therapy, chemotherapy, vaccine treatment, and bone-directed treatment. Factors considered when choosing a treatment plan include age and expected lifespan, other health conditions, stage and grade of cancer, side effects of the treatment predictive outcome of treatment, and patient preferences.

More resources:
American Cancer Society
Cancer Research UK
Prostate Cancer Foundation

Photo by Antony Stanley, via Flick