Prostate Cancer

Prostate Cancer Prostate cancer is the second most commonly diagnosed cancer in men (following skin cancer) and has recently emerged as the leading cause of cancer-related deaths in American men. In 2007 approximately 219, 000 men in the United States will be diagnosed with prostate cancer, and about 27, 000 will die because of this malignancy. Etiology/Risk factors The cause of prostate cancer is unknown, but it is known that two types of tumors are diagnosed in the clinical setting. A latent form can be identified in as many as 30% of men during the fifth decade of life and about 60% to 70% of men in their 80s. Clinically aggressive prostate cancer affects about one in six American men, and it demonstrates the local invasion and metastatic properties of other forms of cancer. Therefore researchers must determine the mechanisms that cause prostate cancer to develop as well as those factors that cause it to progress to the clinically aggressive form that causes men to die of the disease. While these factors are not yet known, a discussion of the risk factors associate with both forms of prostate cancer provides clues that are likely to solve this persistent mystery. 1. Family history of prostate cancer  Men with a family history of prostate cancer are at high risk for developing adenocarcinomas, and 10% of all cases are believed to be inherited. o For example, a focus for prostate cancer susceptibility at a young age has been located on the long arm of chromosome 1, and the PCAP and CAPB genes (both components of chromosome 1) have been identified as leading to an increased risk for prostate cancer. Additional research has identified a gene on the X-chromosome (HPCX) that appears more often in men with prostate cancer, suggesting that the familial predisposition may exhibit heterogeneity (susceptibility based on the expressions of more than one gene). 2. Genetic predisposition  Genetic predisposition to breast cancer has progressed along similar lines, and shared susceptibility loci on chromosome 1 suggest a possible biologic linkage to breast cancer in the women of certain families as well as prostate cancer in the men of these families.  Genetic factors associated with this progression include damage to chromosome 10q, affecting the PTEN/MAC suppression gene; abnormalities of chromosome 12, resulting loss of the tumor suppression of gene p27, and overexpression of gene MYC, because of alteration in the long arm of chromosome 8q.In addition, an abnormality of the AR locus of the X chromosome has been identified that is hypothesized to contribute to the progression of advanced stage prostate cancers from hormone-sensitive to hormone-independent tumors, an ominous event that greatly limits effective treatment option. 3. Age  Prostate cancer increase with age, particularly as men reach sixth decade of life. Approximately thereof four men dignosed with prostate cancer will be age 65 years or older.

4. Race  American men are at greatest risk for developing prostate cancer compared with any other group, and this risk incorporates a greater likelihood of having an advanced stage tumor at initial diagnosisi or dying of prostate cancer. 5. Diet  The greatest dietary risk factor for prostate cancer is the consumption of a diet that is high in saturated animal fats.  Vitamin D deficiency 6. Hormonal imbalance  High level of testosterone has been linked to development of prostate cancer. Absence o functioning testes is associated with absence of BPH or prostate cancer, and consumption of a low-fat, high fiber diet (known to reduce circulating testosterone levels) diminish prostate cancer risk.  More ejaculation were found to lower the risk of prostate cancer development in the ongoing Health Professionals Follow-Up Study (HPFS) of 29,342 U.S. 7. Environmental and occupational factors  It includes living in urban area and specific occupations such as fertilizer, textile, and rubber industries and work with batteries containing cadmium.

Pathophysiology More than 90% of aall cancers arising from the prostate are adenocarcinomas. They typically arise from the peripheral zone of the prostate gland, in contrast no BPH that originates in the transitional zone. A tumor becomes clinically relevant the function when local invasion or distant metastasis interrupts the function of the urinary tract and other organ systems, producing morbidity or death. Whereas no premalignant lesion has been definitely associated with prostate cancer, high grade prostatic intraepithelial neoplasia (PIN) has been found to occur in the same location as adenocacinoma.

Stages of Prostate Cancer The magnitude of local invasion or metastasis is evaluated according to staging system. The tumor, node, metastases (TNM) are used to stage prostate cancer. Stage TI and T2- tumors have remained contained within the prostatic capsule and are diagnosed as localized prostate cancer.

Stage T3 and T4- tumors have spread beyond the prostatic capsule and are classified as advanced stage prostate cancer.