Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow-growing; however, there are cases of aggressive prostate cancers.

The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes.

Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, erectile dysfunction, or death. Other symptoms can potentially develop during later stages of the disease.

Prostate cancer tends to develop in men over the age of fifty. Globally it is the sixth leading cause of cancer-related death in men (it is now the first in the UK and second in the United States).

Prostate cancer is most common in the developed world with increasing rates in the developing world. However, many men with prostate cancer never have symptoms, undergo no therapy, and eventually die of other unrelated causes.

Many factors, including genetics and diet, have been implicated in the development of prostate cancer. Recently the prevalence of light pollution has been implicated in the development of prostate cancer.

The presence of prostate cancer may be indicated by symptoms, physical examination, prostate-specific antigen (PSA), or biopsy. Prostate-specific antigen testing increases cancer detection but does not decrease mortality.

Management strategies for prostate cancer should be guided by the severity of the disease. Many low-risk tumors can be safely followed with active surveillance.

Curative treatment generally involves surgery, various forms of radiation therapy, proton therapy or, less commonly, cryosurgery; hormonal therapy and chemotherapy are generally reserved for cases of advanced disease (although hormonal therapy may be given with radiation in some cases).

The age and underlying health of the man, the extent of metastasis, appearance under the microscope and response of cancer to initial treatment are important in determining the outcome of the disease.

The decision whether or not to treat localized prostate cancer (a tumor that is contained within the prostate) with curative intent is a patient trade-off between the expected beneficial and harmful effects in terms of patient survival and quality of life.

Signs and symptoms

Early prostate cancer usually causes no symptoms. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hyperplasia.

These include frequent urination, nocturia (increased urination at night), difficulty starting and maintaining a steady stream of urine, hematuria (blood in the urine), and dysuria (painful urination). About a third of patients diagnosed with prostate cancer have one or more such symptoms, while two-thirds have no symptoms.

Prostate cancer is associated with urinary dysfunction as the prostate gland surrounds the prostatic urethra. Changes within the gland, therefore, directly affect urinary function.

Because the vas deferens deposits seminal fluid into the prostatic urethra, and secretions from the prostate gland itself are included in semen content, prostate cancer may also cause problems with sexual function and performance.

Advanced prostate cancer can spread to other parts of the body, possibly causing additional symptoms.

The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis, or ribs. Spread of cancer into other bones such as the femur is usually to the proximal part of the bone.

Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence.

An important part of evaluating prostate cancer is determining the stage, or how far the cancer has spread. Knowing the stage helps define prognosis and is useful when selecting therapies.

The most common system is the four-stage TNM system (abbreviated from Tumor/Nodes/Metastases). Its components include the size of the tumor, the number of involved lymph nodes, and the presence of any other metastases.

The most important distinction made by any staging system is whether or not the cancer is still confined to the prostate.

In the TNM system, clinical T1 and T2 cancers are found only in the prostate, while T3 and T4 cancers have spread elsewhere. Several tests can be used to look for evidence of spread.



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