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Cancer (Oncology)

Prostate Cancer

Prostate cancer describes cancers that start in the prostate – a male gland about the size of a walnut found near the rectum and under the bladder. The prostate makes a cushioning fluid for sperm cells in semen. In most cases, prostate cancer – which affects only men – develops slowly over many years, often so slowly that the best treatment is simply watching and waiting.

Prostate cancer, after skin cancer, is the most common cancer in American men and the second leading cause of cancer death (after lung cancer). The lifetime risk of contracting prostate cancer is approximately one in six.

Almost all prostate cancers start in the gland cells. The precise cause of prostate cancer remains unknown, but current thinking holds that changes in DNA can cause cells to grow abnormally.

Risk Factors

The biggest risk factor for prostate cancer is age, followed by race, nationality, family history and genes.

Prostate cancer is rare in men younger than 40, but the frequency increases dramatically over the age of 50. Over 60 percent of prostate cancers are found in men over 65. Prostate cancer is statistically most prevalent in African-American men, followed by Caucasian men, Asian men, and Latino men. The reasons for this statistical disparity are unclear.

Prostate cancer is more common in North America, Western Europe, Australia and the Caribbean. It is less common in Asia, Africa, and South America. Studies are inconclusive as to why that is. Some researchers suspect levels of screening; others suspect differences in diet and lifestyle.

Prostate cancer tends to run in families, suggesting a genetic connection. Men with a father or brother who has contracted prostate cancer are twice as likely as the general population to contract it.

Symptoms and Diagnosis

Prostate cancer often does not produce any symptoms until later in the disease, and many symptoms are also caused by non-cancerous factors. Symptoms include a slowed urinary stream, blood in the urine, impotence, and, if the cancer spreads to bones – pain in the hips and back.

Prostate cancer is most often diagnosed by a digital rectal examination and/or by early testing of the amount of prostate-specific antigen ("PSA") in the blood. PSA testing is thought to have contributed to the declining death rate from prostate cancer over the past two decades. Neither test is 100 percent accurate, however, nor can they indicate how dangerous a detected cancer might be.

Prevention and Treatment

Because the precise cause of prostate cancer is unknown, prevention methods are somewhat speculative. The American Cancer Society recommends maintaining a healthy weight, eating a variety of healthful foods derived from plants and limiting consumption of high-fat and processed meats. There are no formal guidelines for prostate cancer screening; the most common advice is to confer with your doctor.

For those diagnosed with prostate cancer, treatment options vary depending on the age of the patient, his physical condition, and the aggressiveness of the disease. In older men with slow-growing prostate cancer(especially those with other serious health problems), the best option is often active surveillance, sometimes called "watchful waiting."

When treatment is warranted, it may include surgery or radiation, and sometimes men receive both of these therapies. "Systemic therapy" in the form of hormonal therapy is often employed with the hopes of increasing cure rates (especially in combination with radiation). Newer forms of treatment, including more targeted forms of radiation or cryotherapy, are being introduced but there is not yet any long-term data on their efficacy. For men with recurrent or metastatic (spread) prostate cancer, more recent developments have occurred in the past several years than ever before. Many of these treatments were developed in part at NewYork–Presbyterian and are available in the prostate cancer clinics.

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