Topzle Topzle

Prostate cancer

Updated: Wikipedia source

Prostate cancer

Prostate cancer is the uncontrolled growth of cells in the prostate, a gland in the male reproductive system below the bladder. Abnormal growth of the prostate tissue is usually detected through screening tests, typically blood tests that check for prostate-specific antigen (PSA) levels. Those with high levels of PSA in their blood are at increased risk for developing prostate cancer. Diagnosis requires a biopsy of the prostate. If cancer is present, the pathologist assigns a Gleason score; a higher score represents a more dangerous tumor. Medical imaging is performed to look for cancer that has spread outside the prostate. Based on the Gleason score, PSA levels, and imaging results, a cancer case is assigned a stage 1 to 4. A higher stage signifies a more advanced, more dangerous disease. Most prostate tumors remain small and cause no health problems. These are managed with active surveillance, monitoring the tumor with regular tests to ensure it has not grown. Tumors more likely to be dangerous can be destroyed with radiation therapy or surgically removed by radical prostatectomy. Those whose cancer spreads beyond the prostate are treated with hormone therapy which reduces levels of the androgens (masculinizing sex hormones) which prostate cells need to survive. Eventually cancer cells can grow resistant to this treatment. This most-advanced stage of the disease, called castration-resistant prostate cancer, is treated with continued hormone therapy alongside the chemotherapy drug docetaxel. Some tumors metastasize (spread) to other areas of the body, particularly the bones and lymph nodes. There, tumors cause severe bone pain, leg weakness or paralysis, and eventually death. Prostate cancer prognosis depends on how far the cancer has spread at diagnosis. Most men diagnosed have low-risk tumors confined to the prostate; 99% of them survive more than 10 years from their diagnoses. Tumors that have metastasized to distant body sites are most dangerous, with five-year survival rates of 30–40%. The risk of developing prostate cancer increases with age; the average age of diagnosis is 67. Those with a family history of any cancer are more likely to have prostate cancer, particularly those who inherit cancer-associated variants of the BRCA2 gene. Each year 1.2 million cases of prostate cancer are diagnosed, and 350,000 die of the disease, making it the second-leading cause of cancer and cancer death in men. One in eight men are diagnosed with prostate cancer in their lifetime and one in forty die of the disease. Prostate tumors were first described in the mid-19th century, during surgeries on men with urinary obstructions. Initially, prostatectomy was the primary treatment for prostate cancer. By the mid-20th century, radiation treatments and hormone therapies were developed to improve prostate cancer treatment. The invention of hormone therapies for prostate cancer was recognized with the 1966 Nobel Prize to Charles Huggins and the 1977 Prize to Andrzej W. Schally.

Infobox

Other names
Prostate carcinoma
Specialty
Oncology, urology
Symptoms
Typically none. Sometimes trouble urinating, erectile dysfunction, or pain in the back/pelvis.
Usual onset
Age over 40
Risk factors
Older age, family history, race
Diagnostic method
PSA test followed by tissue biopsy
Differential diagnosis
Benign prostatic hyperplasia
Treatment
Active surveillance, prostatectomy, radiation therapy, hormone therapy, chemotherapy
Prognosis
Five-year survival rates range from 30 to 99%, depending on stage.

Tables

AJCC stage for prostate cancer · Diagnosis › Staging
Stage I
Stage I
AJCC Stage
Stage I
TNM scores
T1 or T2, N0, M0
Gleason grade group
1
PSA
<10 ng/mL
Stage IIA
Stage IIA
AJCC Stage
Stage IIA
TNM scores
T1 or T2, N0, M0
Gleason grade group
1
PSA
10–20 ng/mL
Stage IIB
Stage IIB
AJCC Stage
Stage IIB
TNM scores
2
Stage IIC
Stage IIC
AJCC Stage
Stage IIC
TNM scores
3 or 4
Stage IIIA
Stage IIIA
AJCC Stage
Stage IIIA
TNM scores
T1 or T2, N0, M0
Gleason grade group
3 or 4
PSA
> 20 ng/mL
Stage IIIB
Stage IIIB
AJCC Stage
Stage IIIB
TNM scores
T3 or T3, N0, M0
Gleason grade group
10–20 ng/mL
Stage IIIC
Stage IIIC
AJCC Stage
Stage IIIC
TNM scores
T1 or T2, N0, M0
Gleason grade group
5
Stage IVA
Stage IVA
AJCC Stage
Stage IVA
TNM scores
Any T, N1
Gleason grade group
Any group
PSA
Any PSA
Stage IVB
Stage IVB
AJCC Stage
Stage IVB
TNM scores
Any T, M1
AJCC Stage
TNM scores
Gleason grade group
PSA
Stage I
T1 or T2, N0, M0
1
<10 ng/mL
Stage IIA
T1 or T2, N0, M0
1
10–20 ng/mL
Stage IIB
2
Stage IIC
3 or 4
Stage IIIA
T1 or T2, N0, M0
3 or 4
> 20 ng/mL
Stage IIIB
T3 or T3, N0, M0
10–20 ng/mL
Stage IIIC
T1 or T2, N0, M0
5
Stage IVA
Any T, N1
Any group
Any PSA
Stage IVB
Any T, M1

References

  1. The original 1966 Gleason grading system allowed pathologist scores of 1 to 5, resulting in Gleason scores of 2 to 10; h
  2. Cancer incidence often plateaus or falls in the oldest age groups due to reduced diagnosis in people who are already in
  3. Rebello et al. 2021, "Figure 3: Prostate cancer stages and progression.".
  4. Rebello et al. 2021, "Epidemiology".
  5. Scher & Eastham 2022, "Prostate cancer".
  6. "Prostate Cancer Signs and Symptoms"
    https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/signs-symptoms.html
  7. Merriel, Funston & Hamilton 2018, "Symptoms and signs".
  8. Rebello et al. 2021, "Figure 3: Prostate cancer stages and progression".
  9. Coleman et al. 2020, "Prevalence of SREs".
  10. "Symptoms of Prostate Cancer"
    https://www.cancerresearchuk.org/about-cancer/prostate-cancer/symptoms
  11. Coleman et al. 2020, "Prostate cancer".
  12. Clinical Overview 2022, "Clinical presentation".
  13. Scher & Eastham 2022, "Metastatic disease: noncastrate".
  14. Rebello et al. 2021, "Screening and early detection".
  15. "What Is Screening for Prostate Cancer?"
    https://www.cdc.gov/cancer/prostate/basic_info/screening.htm
  16. Carlsson & Vickers 2020, "3. Tailor screening frequency based on PSA-level".
  17. "Screening Tests for Prostate Cancer"
    https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/tests.html
  18. Scher & Eastham 2022, "Prostate-specific antigen".
  19. Carlsson & Vickers 2020, "4. For men with elevated PSA (≥3 ng/mL), repeat PSA.".
  20. Duffy 2020, "Percent free PSA".
  21. Duffy 2020, "Prostate Health Index (PHI)".
  22. Duffy 2020, "4K score".
  23. Duffy 2020, Table 2.
  24. Rebello et al. 2021, "Box 1: Screening for prostate cancer in different regions".
  25. "Tests to Diagnose and Stage Prostate Cancer"
    https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html
  26. Rebello et al. 2021, "Diagnosis".
  27. Scher & Eastham 2022, "Physical examination".
  28. Maffei, Giganti & Moore 2023, "MRI as a test for clinically referred men with a raised PSA or abnormal digital rectal ex
  29. Scher & Eastham 2022, "Prostate biopsy".
  30. Scher & Eastham 2022, "Pathology".
  31. Epstein 2018, "Historical background", "2005 and 2014 ISUP grading conferences", and "Gleason patterns".
  32. Scher & Eastham 2022, "Prostate cancer staging".
  33. "Prostate Cancer Staging"
    https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/staging.html
  34. Scher & Eastham 2022, "Table 87-1 TNM classification".
  35. National Institute for Health and Care Excellence (NICE)
    https://www.nice.org.uk/guidance/ng131/chapter/Recommendations#assessment-and-diagnosis
  36. "Prostate Cancer Risk Groups and the Cambridge Prognostic Group (CPG)"
    https://www.cancerresearchuk.org/about-cancer/prostate-cancer/stages/cambridge-prognostic-group-cpg
  37. Scher & Eastham 2022, "No cancer diagnosis".
  38. Rebello et al. 2021, "Management".
  39. Scher & Eastham 2022, "Active surveillance".
  40. "Initial Treatment of Prostate Cancer, by Stage and Risk Group"
    https://www.cancer.org/cancer/types/prostate-cancer/treating/by-stage.html
  41. "Following PSA Levels During and After Prostate Cancer Treatment"
    https://www.cancer.org/cancer/types/prostate-cancer/treating/psa-levels-after-treatment.html
  42. "Observation or Active Surveillance for Prostate Cancer"
    https://www.cancer.org/cancer/types/prostate-cancer/treating/watchful-waiting.html
  43. Liu et al. 2021, "Reclassification and progression".
  44. Liu et al. 2021, "Abstract".
  45. Rebello et al. 2021, "Localized Disease".
  46. Scher & Eastham 2022, "Clinically localized prostate cancer".
  47. Scher & Eastham 2022, "External beam radiation therapy".
  48. Scher & Eastham 2022, "Brachytherapy".
  49. "Radiation Therapy for Prostate Cancer"
    https://www.cancer.org/cancer/types/prostate-cancer/treating/radiation-therapy.html
  50. Cancer Imaging
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893894
  51. Brawley, Mohan & Nein 2018, "Radiation therapy".
  52. Dall'Era 2023, "Radical prostatectomy".
  53. Costello 2020, "The rise of robotic surgery".
  54. Scher & Eastham 2022, "Radical prostatectomy".
  55. "Following PSA Levels During and After Prostate Cancer Treatment"
    https://www.cancer.org/cancer/types/prostate-cancer/treating/psa-levels-after-treatment.html
  56. Rebello et al. 2021, "Biochemical recurrence and residual disease".
  57. Scher & Eastham 2022, "Rising PSA after definitive local therapy".
  58. Rebello et al. 2021, "Metastatic hormone-sensitive prostate cancer".
  59. "Hormone Therapy for Prostate Cancer"
    https://www.cancer.org/cancer/types/prostate-cancer/treating/hormone-therapy.html
  60. Scher & Eastham 2022, "Testosterone-lowering agents".
  61. Achard et al. 2022, "Introduction".
  62. Scher & Eastham 2022, "Outcomes of androgen deprivation".
  63. Scher & Eastham 2022, "Metastatic disease: castrate".
  64. Rebello et al. 2021, "Metastatic castration-resistant prostate cancer".
  65. International Journal of Molecular Sciences
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924036
  66. Teo, Rathkopf & Kantoff 2019, "Management of metastatic castration-resistant prostate cancer".
  67. Teo, Rathkopf & Kantoff 2019, "Abiraterone acetate".
  68. "FDA Approves Pluvicto for Metastatic Castration-Resistant Prostate Cancer"
    https://web.archive.org/web/20220324031828/https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pluvicto-metastatic-castration-resistant-prostate-cancer
  69. Coleman et al. 2020, "Prevalence of bone metastases".
  70. Coleman et al. 2020, "Analgesics used in CIBP".
  71. Scher & Eastham 2022, "Pain management".
  72. Thompson, Wood & Feuer 2007, "Cord compression".
  73. "What is Metastatic Spinal Cord Compression (MSCC)?"
    https://prostatecanceruk.org/prostate-information-and-support/advanced-prostate-cancer/metastatic-spinal-cord-compression-mscc?scrollTo=symptoms-of-MSCC
  74. Thompson, Wood & Feuer 2007, "Gastrointestinal symptoms".
  75. Thompson, Wood & Feuer 2007, "General debility".
  76. Thompson, Wood & Feuer 2007, "Lymphoedema".
  77. Mundle, Afenya & Agarwal 2021, "Estimates of anxiety, depression, and distress".
  78. Mundle, Afenya & Agarwal 2021, "Abstract".
  79. Thompson, Wood & Feuer 2007, "Delirium".
  80. "Dying from Prostate Cancer – What to Expect"
    https://prostatecanceruk.org/prostate-information-and-support/advanced-prostate-cancer/dying-from-prostate-cancer/what-to-expect
  81. "Care Through the Final Days"
    https://www.cancer.net/navigating-cancer-care/advanced-cancer/care-through-final-days
  82. Rebello et al. 2021, "Prognosis and survival".
  83. Pilié et al. 2022, Table 45-2.
  84. Rebello et al. 2021, "Abstract".
  85. Rebello et al. 2021, "Genetics".
  86. "What Causes Prostate Cancer?"
    https://www.cancer.org/cancer/types/prostate-cancer/causes-risks-prevention/what-causes.html
  87. Rebello et al. 2021, "Disease progression".
  88. "Locally Advanced Prostate Cancer"
    https://www.cancerresearchuk.org/about-cancer/prostate-cancer/stages/locally-advanced-prostate-cancer
  89. Sandhu et al. 2021, "The biology of prostate cancer".
  90. "Understanding Your Pathology Report: Prostatic Intraepithelial Neoplasia (PIN) and Intraductal Carcinoma"
    https://www.cancer.org/cancer/diagnosis-staging/tests/understanding-your-pathology-report/prostate-pathology/high-grade-prostatic-intraepithelial-neoplasia.html
  91. Rebello et al. 2021, "Metastatic disease".
  92. "Prostate Cancer Incidence Statistics"
    https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/incidence#heading-One
  93. Bergengren et al. 2023, "3.1 Epidemiology".
  94. Pernar et al. 2018, "Risk factors for total prostate cancer".
  95. Stephenson, Abouassaly & Klein 2021, "Age at diagnosis".
  96. Dall'Era 2023, "General considerations".
  97. Rebello et al. 2021, "Genetic predisposition".
  98. Scher & Eastham 2022, "Epidemiology".
  99. McHugh et al. 2022, "Introduction".
  100. Pernar et al. 2018, "Risk factors for advanced and fatal prostate cancer".
  101. Pernar et al. 2018, "Statins".
  102. Stephenson, Abouassaly & Klein 2021, "Inflammation and infection".
  103. Pernar et al. 2018, "Exercise".
  104. Pernar et al. 2018, "Fish".
  105. Pernar et al. 2018, "Calcium, dairy products, and vitamin D".
  106. Bertoncelli Tanaka et al. 2022, "Conclusions".
  107. Bertoncelli Tanaka et al. 2022, "Interpretation of PSA in transgender women on GAHT".
  108. Bertoncelli Tanaka et al. 2022, "Screening for prostate cancer in transgender women".
  109. Valier 2016, pp. 15–18.
  110. Med Chir Trans
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129005
  111. Lancet
    https://doi.org/10.1016%2FS0140-6736%2802%2968759-8
  112. Lytton 2001, p. 1859.
  113. Denmeade & Isaacs 2002, "Prostatectomy".
  114. Johns Hopkins Bull
  115. The Prostate
    https://doi.org/10.1002%2Fpros.2990040506
  116. Denmeade & Isaacs 2002, "Radiation therapy".
  117. Denmeade & Isaacs 2002, "Androgen-ablation therapy".
  118. Cancer Res
    https://web.archive.org/web/20170630121943/http://cancerres.aacrjournals.org/content/1/4/293
  119. Proceedings of the National Academy of Sciences of the United States of America
    https://doi.org/10.1073%2Fpnas.79.5.1658
  120. Denmeade & Isaacs 2002, "Cytotoxic chemotherapy".
  121. Desai, McManus & Sharifi 2021, "Evolution of treatment".
  122. Teo, Rathkopf & Kantoff 2019, "Figure 1".
  123. Patel et al. 2020, p. 64.
  124. McIntosh et al. 2023, Table 1.
  125. McIntosh et al. 2023, Table 2.
  126. Mai et al. 2022, "2.1 Human prostate cancer cell lines".
  127. Mai et al. 2022, "2.4. Organoids".
  128. Mai et al. 2022, "2.2 PDX lines".
  129. Mai et al. 2022, "2.3 Genetically engineered mouse model (GEMM)".
  130. Ittmann et al. 2013, "Introduction".
  131. Kokori et al. 2024, "Abstract".
  132. Gandaglia et al. 2021, "3.3.3. Ejaculation frequency and sexual activity".
Image
Source: —
Tip: Wheel or +/− to zoom, drag to pan, Esc to close.