Urology Book

Prostate Disorders

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Prostate Cancer

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  1. Epidemiology
    1. Histologic evidence of prostate cancer on autopsy
      1. Men over age 50 years: 30%
      2. Men over age 80 years: 70%
    2. Clinical Incidence
      1. Incidence (1997 in U.S.): 334,500
      2. Incidence tripled in last 10 years (PSA detection)
      3. Lifetime diagnosis occurs in 9.5% of men
    3. Mortality
      1. Second leading cause of cancer death in men
        1. Second only to Lung Cancer
      2. Mortality: 41,000 deaths per year in U.S.
      3. Mortality increased 24% since 1970s
  2. Risk Factors
    1. Age (Incidental finding on Autopsy)
      1. Age 50 years: 30% Incidence prostate cancer
      2. Age 60 years: 35% Incidence prostate cancer
      3. Age 70 years: 40% Incidence prostate cancer
      4. Age 80 years: 55% Incidence prostate cancer
      5. Age over 90 years: 100% Incidence prostate cancer
    2. Race
      1. Black race confers twice risk of caucasian
      2. Caucasian confers twice risk of asian men
    3. Family History (Relative risk of Prostate Cancer)
      1. First degree relative with Prostate Cancer: RR = 3
      2. Brother with Prostate Cancer before age 63: RR = 4
      3. Sister with Breast Cancer: RR = 2
    4. Factors not with additional cancer risk
      1. Ejaculation frequency not associated with cancer risk
      2. Leitzmann (2004) JAMA 291:1578
  3. Screening for Prostate Cancer
    1. Frequency
      1. Annual exam for men aged 50 years and older
      2. Annual exam for high risk men aged 40 years and older
    2. Testing
      1. Digital Rectal Exam
      2. See Prostate Specific Antigen (PSA)
  4. Classification
    1. See Prostate Cancer Staging (Whitmore Staging)
    2. See Prostate Cancer Histologic grading (Gleason Score)
  5. Complications: Metastasis
    1. Spine Metastasis (90% of prostate cancer metastasis)
      1. Involves vertebral column in 85% of cases
      2. Most often affects lumbar spine
      3. Identified 19 months from initial diagnosis
      4. Recurrence is common (45% risk within 2 years)
    2. Lung Metastasis (50% of prostate cancer metastasis)
      1. Identified 35 months from initial diagnosis
    3. Liver Metastasis (25% of prostate cancer metastasis)
    4. Brain Metastasis (rare)
      1. Identified 60 months from initial diagnosis
      2. Poor prognosis (average survival 7.6 months)
    5. References
      1. Benjamin (2002) Am Fam Physician 65(9):1834
  6. Management
    1. See Prostate Cancer Management
  7. Prevention: Possibly Protective Factors
    1. Exercise (walking)
    2. Soy Protein
    3. Flaxseeds (Phytoestrogens)
    4. Lycopones (tomatoes)
    5. Selenium
    6. Green tea
    7. Vitamin D Supplementation
    8. Calcium Supplementation
    9. Vitamin E Supplementation
    10. Garlic
    11. PC-SPES
    12. Grape seed extract
    13. Zinc
  8. References
    1. Cooner (1994) Prostate Disease, AAFP, p. 9-15

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