Tumors originating in the walnut-shaped gland of the male reproductive system are referred to as prostate cancer (PCa). The median age of diagnosis of the third most common cancer in the USA is 66 and the disease usually has a good prognosis (relative 5-year survival rate of 98.6%). However, African-Americans are more likely to develop and die from the disease. These and other fast facts are summarized in the infographic. As always, please consult your doctor for medical advice.

1. Tumors originating in the walnut-shaped gland of the male reproductive system are referred
to as prostate cancer (PCa). The median age of diagnosis of the third most common cancer
in the USA is 66 and the disease usually has a good prognosis (relative 5-year survival rate
of 98.6%). However, African-Americans are more likely to develop and die from the disease.
1. Definition
Tumor pathology is determined by staging and determining the degree of differentiation of cells
using a Gleason score. While racial differences underlying disease etiology are subjects of ongoing
investigation, it is known that 95% of all PCas are adenocarcinomas. Prostatic intraepithelial
neoplasia ([PIN]) can often be found with these tumors. Other rare carcinomas are Intralobular
acinar, ductal, clear cell, mucinous, and small-cell tumors.
2. Diagnosis
This second-leading cause of cancer death among US men is more likely to be diagnosed at a
younger age and more advanced stage in African-Americans versus their Caucasian
counterparts. Other risk factors include a high-fat diet and a genetic
predisposition. Examination of genitourinary symptoms will be accompanied by pathologic
analysis, biomarker tests (eg, prostate-specific antigen and PCA3), and imaging tests.
3. Familial PCa
Early-onset prostate cancer (age ≤55 years), many first-degree relatives affected by the illness, or a a
family history of other cancers (e.g., breast, ovarian, pancreatic) may suggest a genetic predisposition
for PCa. Variations in BRCA1, BRCA2, the mismatch repair genes, and HOXB13 have been associated
with modest to high lifetime risk of PCa. Although information is limited, some experts have
suggested using biomarkers to screen for more aggressive disease and to assess treatment
responses within appropriate contexts.
4. Treatment
Expectant management, surgery, brachytherapy (temporary or permanent surgical
implantation of radioactive sources into the prostate gland), external beam radiation therapy,
androgen deprivation therapy, or a combination of 2 or more of the above modalities form
the cornerstones of any given treatment strategy.
5. Emerging therapies
High-intensity focused ultrasound or cryotherapies are among the emerging treatment options.
Androgen replacement has been shown to be a viable option in select case series. Hypo-
fractionated radiation therapy and 5-alpha reductase inhibitors are also under investigation. As
PCa preferentially metastasizes to the bone, several therapies are in development to target
premetastatic niches. The tumor may also be amenable to other targeted and immunotherapies.
6. Complications
Short-term radiation-induced dysuria, erectile dysfunction, hormone-induced hot
flashes/metabolic derangements/cognitive impairment, and hematuria are among the
reported complications that can occur to varying extents in some individuals.
7. Prevention
Currently, there is no formal primary prevention plan in place in the USA. At this point, it seems that treatment
with 5-alpha-reductase inhibitors does not prevent PCa, but may help shrink slow-growing tumors. A low-fat
diet may help to prevent PCa. Glossary
PCA3, a non-coding tissue-specific RNA that is overexpressed in prostate cancer. This biomarker may be useful in determining which men with previously negative biopsies
should undergo repeat biopsy (i.e., those with a PCA3 score >35)
Sources
Chornokur G, Dalton K, Borysova M, et al. The Prostate. 2011;71(9):985-997; Epocrates (An Athenahealth company): Prostate Cancer. 2017;
https://online.epocrates.com/diseases/25421/Prostate-cancer/; US National Institutes of Health.National Cancer Institute. https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq;
US National Institutes of Health. National Cancer Institute Surveillance, Epidemiology and End Results Program.017; https://seer.cancer.gov/statfacts/html/prost.html.Harvard Medical School. 2015;
http://www.harvardprostateknowledge.org/prostate-cancer-risk-in-african-americans.