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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | __NOTOC__ |
| | '''For patient information click [[Prostate cancer (patient information)|here]].''' |
| | {{Prostate cancer}} |
| | {{SCC}}; {{MJM}}; {{AE}} {{SC}} {{sali}} {{KKV}} |
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| {{DiseaseDisorder infobox | | | {{SK}} Prostate adenocarcinoma, neoplasm of prostate, tumor of prostate, tumor of prostate, malignant tumor of the prostate, cancer of the prostate, malignant prostatic tumor, malignant prostatic tumour, malignant tumor of prostate |
| Name = Prostate cancer |
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| ICD10 = {{ICD10|C|61||c|60}} |
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| ICD9 = {{ICD9|185}} |
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| Image = Prostatelead.jpg |
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| Caption = |
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| ICDO = |
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| OMIM = 176807 |
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| DiseasesDB = 10780 |
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| MedlinePlus = 000380 |
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| MeshID = D011471 |
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| }} | |
| {{Prostate cancer}}
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| {{SCC}}
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| {{Editor Join}}
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| ==[[Prostate cancer overview|Overview]]== | | ==[[Prostate cancer overview|Overview]]== |
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| ==[[Prostate cancer history and symptoms|Symptoms]]== | | ==[[Prostate cancer historical perspective|Historical Perspective]]== |
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| | ==[[Prostate cancer classification|Classification]]== |
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| ==[[Prostate cancer pathophysiology|Pathophysiology]]== | | ==[[Prostate cancer pathophysiology|Pathophysiology]]== |
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| ==[[Prostate cancer causes|Causes]]== | | ==[[Prostate cancer causes|Causes]]== |
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| ==Treatment== | | ==[[Prostate cancer differential diagnosis|Differentiating Prostate Cancer from other Cancers]]== |
| Treatment for prostate cancer may involve [[watchful waiting]], [[surgery]], [[radiation therapy]] including [[brachytherapy]] (prostate brachytherapy) and external beam radiation, [[High Intensity Focused Ultrasound (HIFU)]], [[chemotherapy]], [[cryosurgery]], hormonal therapy, or some combination. Which option is best depends on the stage of the disease, the Gleason score, and the PSA level. Other important factors are the man's age, his general health, and his feelings about potential treatments and their possible side effects. Because all treatments can have significant [[Adverse effect (medicine)|side effect]]s, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations.
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| The selection of treatment options may be a complex decision involving many factors. For example, radical prostatectomy after primary radiation failure is a very technically challenging surgery and may not be an option.<ref name="pmid16314889">{{cite journal | author = Mouraviev V, Evans B, Polascik TJ | title = Salvage prostate cryoablation after primary interstitial brachytherapy failure: a feasible approach | journal = Prostate Cancer Prostatic Dis. | volume = 9 | issue = 1 | pages = 99–101 | year = 2006 | pmid = 16314889 | doi = 10.1038/sj.pcan.4500853 | url = }}</ref> This may enter into the treatment decision.
| | ==[[Prostate cancer epidemiology and demographics|Epidemiology and Demographics]]== |
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| If the cancer has spread beyond the prostate, treatment options significantly change, so most doctors who treat prostate cancer use a variety of [[nomogram]]s to predict the probability of spread. Treatment by watchful waiting, HIFU, radiation therapy, cryosurgery, and surgery are generally offered to men whose cancer remains within the prostate. Hormonal therapy and chemotherapy are often reserved for disease which has spread beyond the prostate. However, there are exceptions: radiation therapy may be used for some advanced tumors, and hormonal therapy is used for some early stage tumors. [[Cryotherapy]], hormonal therapy, and chemotherapy may also be offered if initial treatment fails and the cancer progresses.
| | ==[[Prostate cancer risk factors|Risk Factors]]== |
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| [[Prostate cancer medical therapy|Medical therapy]] | [[Prostate cancer surgery|Surgical options]] | [[Prostate cancer metastasis treatment|Metastasis Treatment]] | [[Prostate cancer primary prevention|Primary prevention]] | [[Prostate cancer secondary prevention|Secondary prevention]] | [[Prostate cancer cost-effectiveness of therapy|Financial costs]] | [[Prostate cancer future or investigational therapies|Future therapies]] | | ==[[Prostate cancer screening|Screening]]== |
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| ==[[Prostate cancer screening|Screening]]== | | ==[[Prostate cancer natural history|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| [[Image:Prostatehistopath.jpg|thumb|right|500px|'''Normal prostate (A) and prostate cancer (B).''' In prostate cancer, the regular glands of the normal prostate are replaced by irregular glands and clumps of cells, as seen in these pictures taken through a microscope.]]
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| When a man has symptoms of prostate cancer, or a screening test indicates an increased risk for cancer, more invasive evaluation is offered.
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| The only test which can fully confirm the diagnosis of prostate cancer is a [[biopsy]], the removal of small pieces of the prostate for microscopic examination. However, prior to a biopsy, several other tools may be used to gather more information about the prostate and the urinary tract. [[Cystoscopy]] shows the urinary tract from inside the bladder, using a thin, flexible camera tube inserted down the [[urethra]]. [[Transrectal ultrasonography]] creates a picture of the prostate using sound waves from a probe in the rectum.
| | [[Prostate cancer history and symptoms| History and Symptoms]] | [[Prostate cancer physical examination | Physical Examination]] | [[Prostate cancer staging | Staging]] | [[Prostate cancer laboratory studies | Laboratory Findings]] | [[Prostate cancer x ray|X Ray]] | [[Prostate cancer CT|CT]] | [[Prostate cancer MRI|MRI]] | [[Prostate cancer ultrasound| Ultrasound]] | [[Prostate cancer other imaging findings|Other Imaging Findings]] | [[Prostate cancer other diagnostic studies|Other Diagnostic Studies]] | [[Prostate cancer biopsy|Biopsy]] |
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| :[[Prostate cancer history and symptoms| History and Symptoms]] | [[Prostate cancer physical examination | Physical Examination]] | [[Prostate cancer staging | Staging]] | [[Prostate cancer laboratory studies | Lab Studies]] | [[Prostate cancer electrocardiogram|Electrocardiogram]] | [[Prostate cancer x ray|X Ray]] | [[Prostate cancer MRI|MRI]] | [[Prostate cancer CT|CT]] | [[Prostate cancer echocardiography|Echocardiography]] | [[Prostate cancer other imaging findings|Other imaging findings]] | [[Prostate cancer other diagnostic studies|Other diagnostic studies]]
| | ==Treatment== |
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| ==[[Prostate cancer risk factors|Risk factors]]== | |
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| ==[[Prostate cancer natural history|Complications & Prognosis]]==
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| ==Progression==
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| In 1941, Charles Huggins reported that [[androgen]] ablation therapy causes regression of primary and metastatic androgen-dependent prostate cancer.<ref>Huggins C, Steven RE and Hodges CV, Studies on prostatic cancer. Arch. Sug. 43:209–223, 1941.</ref> [[Androgen]] ablation therapy causes remission in 80-90% of patients undergoing therapy, resulting in a median progression-free survival of 12 to 33 months. After remission an androgen-independent phenotype typically emerges, where the median overall survival is 23–37 months from the time of initiation of [[androgen]] ablation therapy.<ref>Hellerstedt BA and Pienta KJ, The current state of hormonal therapy for prostate cancer, CA Cancer J. Clin. 52: 154–179, 2002.PMID 12018929</ref> The actual mechanism contributes to the progression of prostate cancer is not clear and may vary between individual patient. A few possible mechanisms have been proposed.<ref>Feldman BJ, Feldman D. The development of androgen-independent prostate cancer. Nat Rev Cancer. 2001 Oct;1(1):34–45. PMID 11900250</ref> Scientists have established a few prostate cancer cell lines to investigate the mechanism involved in the progression of prostate cancer. LNCaP, PC-3, and DU-145 are commonly used prostate cancer cell lines. The LNCaP cancer cell line was established from a human lymph node metastatic lesion of prostatic adenocarcinoma. PC-3 and DU-145 cells were established from human prostatic adenocarcinoma metastatic to bone and to brain, respectively. LNCaP cells express [[androgen receptor]] (AR), however, PC-3 and DU-145 cells express very little or no AR. AR, an androgen-activated [[transcription factor]], belongs to the steroid [[nuclear receptor]] family. Development of the prostate is dependent on androgen signaling mediated through AR, and AR is also important during the development of prostate cancer. The proliferation of LNCaP cells is [[androgen]]-dependent but the proliferation of PC-3 and DU-145 cells is [[androgen]]-insensitive.Elevation of AR expression is often observed in advanced prostate [[tumor]]s in patients.<ref>Linja MJ, Savinainen KJ, Saramaki OR, Tammela TL, Vessella RL, Visakorpi T. Amplification and overexpression of androgen receptor gene in hormone-refractory prostate cancer. Cancer Res. 2001 May 1;61(9):3550–5. PMID 11325816</ref><ref>Ford OH 3rd, Gregory CW, Kim D, Smitherman AB, Mohler JL. Androgen receptor gene amplification and protein expression in recurrent prostate cancer. J Urol. 2003 Nov;170(5):1817–21.PMID 14532783</ref> Some androgen-independent LNCaP sublines have been developed from the ATCC androgen-dependent LNCaP cells after androgen deprivation for study of prostate cancer progression. These [[androgen]]-independent LNCaP cells have elevated [[AR]] expression and express [[prostate specific antigen]] upon [[androgen]] treatment. [[Androgen]]s paradoxically inhibit the proliferation of these [[androgen]]-independent prostate [[cancer]] cells.<ref>Kokontis J, Takakura K, Hay N, Liao S. Increased androgen receptor activity and altered c-myc expression in prostate cancer cells after long-term androgen deprivation. Cancer Res. 1994 March 15;54(6):1566–73. PMID 7511045</ref><ref>Umekita Y, Hiipakka RA, Kokontis JM, Liao S. Human prostate tumor growth in athymic mice: inhibition by androgens and stimulation by finasteride. Proc Natl Acad Sci U S A. 1996 October 15;93(21):11802-7. PMID 8876218</ref><ref>Kokontis JM, Hsu S, Chuu CP, Dang M, Fukuchi J, Hiipakka RA, Liao S. Role of androgen receptor in the progression of human prostate tumor cells to androgen independence and insensitivity. Prostate. 2005 December 1;65(4):287-98. PMID 16015608</ref> [[Androgen]] at a concentration of 10-fold higher than the physiological concentration has also been shown to cause growth suppression and reversion of androgen-independent prostate cancer xenografts or androgen-independent prostate tumors derived [[in vivo]] model to an [[androgen]]-stimulated phenotype in athymic mice.<ref>Chuu CP, Hiipakka RA, Fukuchi J, Kokontis JM, Liao S. Androgen causes growth suppression and reversion of androgen-independent prostate cancer xenografts to an androgen-stimulated phenotype in athymic mice. Cancer Res. 2005 March 15;65(6):2082–4. PMID 15781616 </ref><ref>Chuu CP, Hiipakka RA, Kokontis JM, Fukuchi J, Chen RY, Liao S. Inhibition of tumor growth and progression of LNCaP prostate cancer cells in athymic mice by androgen and liver X receptor agonist. Cancer Res. 2006 July 1;66(13):6482–6. PMID 16818617</ref> These observation suggest the possibility to use androgen to treat the development of relapsed androgen-independent prostate tumors in patients. Oral infusion of [[green tea]] [[polyphenols]], a potential alternative therapy for prostate cancer by natural compounds, has been shown to inhibit the development, progression, and [[metastasis]] as well in autochthonous transgenic adenocarcinoma of the mouse prostate (TRAMP) model, which spontaneously develops prostate cancer.<ref>Gupta S, Hastak K, Ahmad N, Lewin JS, Mukhtar H. Inhibition of prostate carcinogenesis in TRAMP mice by oral infusion of green tea polyphenols. Proc Natl Acad Sci U S A. 2001 August 28;98(18):10350-5. PMID 11504910</ref>
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| ==Epidemiology==
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| Rates of prostate cancer vary widely across the world. Although the rates vary widely between countries, it is least common in South and East Asia, more common in Europe, and most common in the United States.<ref>{{cite web | url = http://web.archive.org/web/20060205235509/http://www.jncicancerspectrum.oxfordjournals.org/cgi/statContent/cspectfstat;99 | title = IARC Worldwide Cancer Incidence Statistics—Prostate | publisher = Oxford University Press | work = JNCI Cancer Spectrum | date = December 19, 2001}} Retrieved on 2007-04-05 through the Internet Archive</ref> According to the [[American Cancer Society]], prostate cancer is least common among Asian men and most common among black men, with figures for white men in-between.<ref> [http://www.cancer.org/docroot/CRI/content/CRI_2_2_2X_What_causes_prostate_cancer_36.asp?sitearea= Overview: Prostate Cancer—What Causes Prostate Cancer?] American Cancer Society (2006-05-02). Retrieved on 2007-04-05</ref><ref> [http://www.hsc.stonybrook.edu/som/urology/urology_cp_prostatecancer.cfm Prostate Cancer FAQs.] State University of New York School of Medicine Department of Urology (2006-08-31). Retrieved on 2007-04-05</ref> However, these high rates may be affected by increasing rates of detection.<ref>{{cite journal |author=Potosky A, Miller B, Albertsen P, Kramer B |title=The role of increasing detection in the rising incidence of prostate cancer |journal=[[Journal of the American Medical Association|JAMA]] |volume=273 |issue=7 |pages=548–52 |year=1995 |pmid=7530782 |doi=10.1001/jama.273.7.548}}</ref>
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| Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except [[lung cancer]]. In the United Kingdom it is also the second most common cause of cancer death after lung cancer, where around 35,000 cases are diagnosed every year and of which around 10,000 die of it. However, many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. That is because malignant [[neoplasm]]s of the prostate are, in most cases, slow-growing, and because most of those affected are over 60. Hence they often die of causes unrelated to the prostate cancer, such as heart/circulatory disease, pneumonia, other unconnected cancers or old age. Many factors, including [[genetics]] and [[Diet (nutrition)|diet]], have been implicated in the development of prostate cancer. The Prostate Cancer Prevention Trial found that [[finasteride]] reduces the incidence of prostate cancer rate by 30%. There had been a controversy about this also increasing the risk of more aggressive cancers, but more recent research showed this was not the case.<ref>{{ cite news | author = Gine Kolata | title = New Take on a Prostate Drug, and a New Debate | url = http://www.nytimes.com/2008/06/15/health/15prostate.html?ei=5087&em=&en=813eaa4e10f57756&ex=1213675200&adxnnl=1&adxnnlx=1213503418-GD4DbGjYsDxqV/xuGWnE1A | publisher = NY Times | date = June 15, 2008 | accessdate = 2008-06-15 }}</ref><ref>{{cite journal |author=Potosky A, Miller B, Albertsen P, Kramer B |title=Finasteride Does Not Increase the Risk of High-Grade Prostate Cancer: A Bias-Adjusted Modeling Approach | url = http://cancerpreventionresearch.aacrjournals.org/cgi/rapidpdf/1940-6207.CAPR-08-0092v1 |journal= Cancer Prevention Research |volume= Published Online First on May 18, 2008 as 10.1158/1940-6207.CAPR-08-0092 |year=2008 |doi=10.1158/1940-6207.CAPR-08-0092 |pages=174 }}</ref>
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| == History ==
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| [[Image:Schally portrait.jpg|right|thumb|150px|'''Andrzej W. Schally''' was awarded the 1977 Nobel Prize in Medicine for his research relating to prostate cancer.]]
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| Although the prostate was first described by Venetian anatomist [[Niccolò Massa]] in 1536, and illustrated by Flemish anatomist [[Vesalius|Andreas Vesalius]] in 1538, prostate cancer was not identified until 1853.<ref>Adams, J. ''The case of scirrhous of the prostate gland with corresponding affliction of the lymphatic glands in the lumbar region and in the pelvis.'' Lancet 1, 393 (1853).</ref> Prostate cancer was initially considered a rare disease, probably because of shorter [[life expectancy|life expectancies]] and poorer detection methods in the 19th century. The first treatments of prostate cancer were surgeries to relieve urinary obstruction.<ref>Lytton, B. ''Prostate cancer: a brief history and the discovery of hormonal ablation treatment.'' J. Urol. 165, 1859–1862</ref> Removal of the entire gland (radical perineal [[prostatectomy]]) was first performed in 1904 by Hugh H. Young at [[Johns Hopkins Hospital]].<ref>Young, H. H. ''Four cases of radical prostatectomy.'' Johns Hopkins Bull. 16, 315 (1905).</ref> Surgical removal of the testes ([[orchiectomy]]) to treat prostate cancer was first performed in the 1890s, but with limited success. [[Transurethral resection of the prostate]] (TURP) replaced radical prostatectomy for symptomatic relief of obstruction in the middle of the 20th century because it could better preserve penile erectile function. Radical retropubic prostatectomy was developed in 1983 by Patrick Walsh.<ref>Walsh, P. C., Lepor, H. & Eggleston, J. C. ''Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations.'' Prostate 4, 473-485 (1983). PMID 6889192</ref> This surgical approach allowed for removal of the prostate and lymph nodes with maintenance of penile function.
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| In 1941 Charles B. Huggins published studies in which he used [[estrogen]] to oppose testosterone production in men with metastatic prostate cancer. This discovery of "chemical [[castration]]" won Huggins the 1966 [[Nobel Prize in Physiology or Medicine]].<ref>Huggins, C. B. & Hodges, C. V. ''Studies on prostate cancer: 1. The effects of castration, of estrogen and androgen injection on serum phosphatases in metastatic carcinoma of the prostate.'' Cancer Res. 1, 203 (1941).</ref> The role of the hormone [[GnRH]] in reproduction was determined by Andrzej W. Schally and [[Roger Guillemin]], who both won the 1977 Nobel Prize in Physiology or Medicine for this work.
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| Receptor agonists, such as [[leuprolide]] and [[goserelin]], were subsequently developed and used to treat prostate cancer.<ref>Schally, A. V., Kastin, A. J. & Arimura, A. ''Hypothalamic FSH and LH-regulating hormone. Structure, physiology and clinical studies.'' Fertil. Steril. 22, 703–721 (1971).</ref><ref>Tolis G, Ackman D, Stellos A, Mehta A, Labrie F, Fazekas AT, Comaru-Schally AM, Schally AV. ''Tumor growth inhibition in patients with prostatic carcinoma treated with luteinizing hormone-releasing hormone agonists.'' Proc Natl Acad Sci U S A. 1982 Mar;79(5):1658–62 PMID 6461861</ref>
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| [[Radiation therapy]] for prostate cancer was first developed in the early 20th century and initially consisted of intraprostatic [[radium]] implants. External beam radiation became more popular as stronger radiation sources became available in the middle of the 20th century. Brachytherapy with implanted seeds was first described in 1983.<ref>Denmeade SR, Isaacs JT. ''A History of Prostate Cancer Treatment.'' Nature Reviews Cancer 2, 389–396 (2002). PMID 12044015</ref> Systemic chemotherapy for prostate cancer was first studied in the 1970s. The initial regimen of [[cyclophosphamide]] and [[5-fluorouracil]] was quickly joined by multiple regimens using a host of other systemic chemotherapy drugs.<ref>Scott, W. W. et al. ''Chemotherapy of advanced prostatic carcinoma with cyclophosphamide or 5-fluorouracil: results of first national randomized study.'' J. Urol. 114, 909–911 (1975). PMID 1104900</ref>
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| ==Histopathological Findings in Prostatic Adenocarcinoma==
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| === Prostate: Adenocarcinoma===
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| <youtube v=1SZPLS1dxTo/>
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| == Prostate: Adenocarcinoma (Gleason grading system)==
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| === Prostate: Adenocarcinoma (Gleason grade 1)===
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| <youtube v=F7V0Zl7a2FY/>
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| === Prostate : Adenocarcinoma (Gleason grade 2)===
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| <youtube v=YSOLiSklIXw/>
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| === Prostate : Adenocarcinoma (Gleason grade 3)===
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| <youtube v=TG8vR_pE7yA/>
| | [[Prostate cancer medical therapy|Medical Therapy]] | [[Prostate cancer surgery|Surgery]] | [[Prostate cancer primary prevention|Primary Prevention]] | [[Prostate cancer secondary prevention|Secondary Prevention]] | [[Prostate cancer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Prostate cancer future or investigational therapies|Future or Investigational Therapies]] | [[Prostate cancer alternative therapy|Alternative Therapy]] |
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| === Prostate: Adenocarcinoma (Gleason grade 4)=== | | ==Case Studies== |
| | [[Prostate cancer case study one|Case #1]] |
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| <youtube v=R2Cl4HScdGc/>
| | ==Related Chapters== |
| | | * [[Atypical small acinar proliferation]] |
| === Prostate: Adenocarcinoma (Gleason grade 5)=== | | * [[Testosterone]] |
| | | * [[Gleason score]] |
| <youtube v=F7V0Zl7a2FY/>
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| == See also ==
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| *[[Atypical small acinar proliferation]] | |
| *[[Testosterone]] | |
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| ==References==
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| {{reflist|2}}
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| ==External links==
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| *[http://www.youtube.com/watch?v=gqEOYBNnqb4 Prostate Cancer & Endothelin: PMAP The Proteolysis Map - animation] | |
| *{{dmoz|Health/Conditions_and_Diseases/Cancer/Genitourinary/Prostate/}}
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| {{Urogenital neoplasia}} | | {{Urogenital neoplasia}} |
| {{SIB}}
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| {{Link FA|ca}}
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| {{Link FA|de}}
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| [[af:Prostaatkanker]]
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| [[bn:প্রোস্টেট ক্যান্সার]]
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| [[bg:Рак на простатата]]
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| [[ca:Càncer de pròstata]]
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| [[da:Prostatakræft]]
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| [[de:Prostatakrebs]]
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| [[dv:ޕްރޮސްޓޭޓް ކެންސަރު]]
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| [[el:Καρκίνος του προστάτη]]
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| [[es:Cáncer de próstata]]
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| [[fa:سرطان پروستات]]
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| [[fr:Cancer de la prostate]]
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| [[hr:Rak prostate]]
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| [[id:Kanker prostat]]
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| [[it:Carcinoma della prostata]]
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| [[he:סרטן הערמונית]]
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| [[la:Cancer prostatae]]
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| [[lv:Prostatas vēzis]]
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| [[nl:Prostaatkanker]]
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| [[ja:前立腺癌]]
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| [[no:Prostatakreft]]
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| [[pl:Rak gruczołu krokowego]]
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| [[pt:Câncer de próstata]]
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| [[ru:Рак простаты]]
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| [[simple:Prostate cancer]]
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| [[fi:Eturauhassyöpä]]
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| [[sv:Prostatacancer]]
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| [[tl:Kanser sa prostata]]
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| [[tr:Prostat kanseri]]
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| [[zh:前列腺癌]]
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