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'''Jim Coane''' is an award winning television producer, writer and director. He is the creator of PBS' preschool series ''[[Dragon Tales]]''. He is also credited as executive producer on many network, syndication and cable series, including ''Walking the Bible'', ''[[Totally Hidden Video]]'', ''[[Card Sharks]]'', ''Futurequest'', ''[[America's Most Wanted]]'', ''Forces Beyond'', and ''Superstars of Action''.
{{DiseaseDisorder infobox |
Name = Prostate cancer |
ICD10 = {{ICD10|C|61||c|60}} |
ICD9 = {{ICD9|185}} |
Image = Prostatelead.jpg |
Caption = |
ICDO = |
OMIM = 176807 |
DiseasesDB = 10780 |
MedlinePlus = 000380 |
eMedicineSubj = radio |
eMedicineTopic = 574 |
}}
'''Prostate cancer''' is a [[disease]] in which [[cancer]] develops in the [[prostate]], a gland in the [[male]] [[reproductive system]]. Cancer occurs when [[cell (biology)|cell]]s of the prostate [[Mutation|mutate]] and begin to multiply out of control. These cells may spread ([[Metastasis|metastasize]]) from the prostate to other parts of the body, especially the [[bone]]s and [[lymph node]]s. Prostate cancer may cause pain, difficulty in [[urination|urinating]], [[erectile dysfunction]] and other [[symptom]]s.
Coane has executive produced over 500 hundred hours of series, specials and pilots for ABC, CBS, NBC, FOX, USA, Turner, Discovery Channel, Learning Channel, PBS, F/X and other broadcasters. He received an [[Emmy award]] for the PBS documentary series ''Futurequest'' and his animated children's series ''[[Dragon Tales]]'' has been nominated three times for an Emmy. He worked on staff in overall producer deals at [[Sony Television]] and [[Fox Television Studios]] and was president of the production division of Unapix Productions.
Rates of prostate cancer vary widely across the world. Although the rates vary widely between countries, it is least common in South and East Asia, more common in Europe, and most common in the United States.<ref>{{cite web | url = http://web.archive.org/web/20060205235509/http://www.jncicancerspectrum.oxfordjournals.org/cgi/statContent/cspectfstat;99 | title = IARC Worldwide Cancer Incidence Statistics—Prostate | publisher = [[Oxford University Press]] | work = JNCI Cancer Spectrum | date = December 19, 2001}} Retrieved on [[2007-04-05]] through the [[Internet Archive]]</ref> According to the [[American Cancer Society]], prostate cancer is least common among Asian men and most common among black men, with figures for European men in-between.<ref> [http://www.cancer.org/docroot/CRI/content/CRI_2_2_2X_What_causes_prostate_cancer_36.asp?sitearea= Overview: Prostate Cancer—What Causes Prostate Cancer?] American Cancer Society ([[2006-05-02]]). Retrieved on [[4007-04-05]]</ref><ref> [http://www.hsc.stonybrook.edu/som/urology/urology_cp_prostatecancer.cfm Prostate Cancer FAQs.] State University of New York School of Medicine Department of Urology ([[2006-08-31]]). Retrieved on [[2007-04-05]]</ref> However, these high rates may be affected by increasing rates of detection.<ref>{{cite journal |author=Potosky A, Miller B, Albertsen P, Kramer B |title=The role of increasing detection in the rising incidence of prostate cancer |journal=[[Journal of the American Medical Association|JAMA]] |volume=273 |issue=7 |pages=548–52 |year=1995 |pmid=7530782}}</ref>
==Biography==
Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except [[lung cancer]]. However, many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. Many factors, including [[genetics]] and [[Diet (nutrition)|diet]], have been implicated in the development of prostate cancer.
Born July 31, 1948, in Trenton, N.J., Coane is a graduate of The Hun School of Princeton and Rutgers University. He was married to Amy Fromer in 1984 and has two children, Max and Cassie. He began his career as a producer at MPO Productions in New York City before becoming a director of TV commercials at his production company, Coane Productions, Inc. He is a member of the [[Director's Guild of America]] and the [[Producers Guild of America]]. He currently resides in Santa Monica, CA.
== Television credits ==
Prostate cancer is most often discovered by [[physical examination]] or by screening [[blood test]]s, such as the PSA ([[prostate specific antigen]]) test. There is some current concern about the accuracy of the PSA test and its usefulness. Suspected prostate cancer is typically confirmed by removing a piece of the prostate ([[biopsy]]) and examining it under a [[microscope]]. Further tests, such as [[X-ray]]s and [[bone scan]]s, may be performed to determine whether prostate cancer has spread.
* Dragon Tales - Multi Emmy nominated pre-school animation series.
* Walking The Bible - Three documentary hours hosted by author Bruce Feiler.
* Future Quest - Emmy award winning documentary series. Hosted by Jeff Goldblum.
* Totally Hidden Video - Two seasons of hidden camera comedy series for FOX Network.
* Poker Royale - Poker series for Game Show Network.
* Card Sharks - Nationally syndicated game show based on Goodson/Todman format.
* America's Most Wanted - Producer during premier season of long running FOX series
* Love Behind Bars - Looks at love and relationships in prison.
* Prison Doctors - Profile of health system ni prison.
* Letters From A Nut - Pilot for ABC based on popular book.
* Nothing's On - Pilot for F/X
* Wild on the Set - Series features animal actors and their trainers.
* Totally Out of Control - Focus on totally outrageous and unusual people, machines, weather.
* Forces Beyond - Series investigated both sides of the paranormal debate. Hosted by Nick Mancuso.
* Superstars of Action - Biography series of Hollywood’s greatest action stars, hosted by Robert Wagner.
* Hollywood Stuntmakers - Behind the scenes look at Hollywood’s greatest action movies, hosted by James Coburn.
* Hollywood F/X MASTERS - Thirteen half-hours about Hollywood’s greatest special effects, hosted by Christopher Reeve.
* Record Setters - Three hours that profiles world records.
* Now you See It - Three hours that looks at history and mystery of magic.
* Fifty Years OF Hanna/Barbara Cartoons - TNT - One hour Special hosted by John Goodman.
* Laurie Cooks Light and Easy - Cooking series with author/chef Laurie Burrows Grad.
* Home green Home - Gardening/craft/cooking series for PBS hosted Kelley Shea Smith.
* Simply Style - Fashion and style series for Discovery Network with host/author Leah Feldon.
* Family Values - Hidden camera game show pilot produced for Fox Television.
* Payback - Hidden camera game show pilot produced for Fox Television.
* High School Confidential - Produced and directed soap opera pilot for FOX TV.
==Awards==
Prostate cancer can be treated with [[surgery]], [[radiation therapy]], [[hormone therapy]], occasionally [[chemotherapy]], [[proton therapy]], or some combination of these. The age and underlying health of the man as well as the extent of spread, appearance under the microscope, and response of the cancer to initial treatment are important in determining the outcome of the disease. Since prostate cancer is a disease of older men, many will die of other causes before a slowly advancing prostate cancer can spread or cause symptoms. This makes treatment selection difficult.<ref>{{cite web| publisher=American Cancer Society webpage| title=Detailed Guide: prostate cancer| url=http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=36}}</ref> 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.
*1990 [[Emmy Award]], for ''Futurequest'' PBS Non-fiction series.
*1999 Emmy nomination, Executive Producer, Best Animated Children's Series, for ''Dragon Tales''
*2000 Parents Choice Award for "Dragon Tales"
*2000 Emmy nomination, Consulting Producer, Best Animated Children's Series, for ''Dragon Tales''
*2001 Emmy nomination, Consulting Producer, Best Animated Children's Series, for ''Dragon Tales''
==ProstateExternal links==
*{{imdb name|id=0167585|name=James Coane}}
{{main|Prostate}}
* [http://movies2.nytimes.com/gst/movies/filmography.html?p_id=279656 Jim Coane filmography at the New York Times]
The [[prostate]] is a male [[reproductive system|reproductive]] [[organ (anatomy)|organ]] which helps make and store [[seminal fluid]]. In adult men a typical prostate is about three centimeters long and weighs about twenty grams.<ref>{{cite book| last=Aumüller| first=G.| title=Prostate Gland and Seminal Vesicles| publisher=Springer-Verlag| ___location=Berlin-Heidelberg| year=1979}}</ref> It is located in the [[pelvis]], under the [[urinary bladder]] and in front of the [[rectum]]. The prostate surrounds part of the [[urethra]], the tube that carries [[urine]] from the bladder during [[urination]] and semen during [[ejaculation]].<ref>{{cite book| last=Moore| first=K.| coauthors=Dalley, A.| title=Clinically Oriented Anatomy| publisher=Lippincott Williams & Wilkins| ___location=Baltimore, Maryland| year=1999}}</ref> Because of its ___location, prostate diseases often affect urination, ejaculation, and rarely [[defecation]]. The prostate contains many small [[gland]]s which make about twenty percent of the fluid comprising semen.<ref>{{cite book| last=Steive| first=H.| chapter=Männliche Genitalorgane| title=Handbuch der mikroskopischen Anatomie des Menschen. Vol. VII Part 2| pages=1–399| ___location=Berlin| publisher=Springer| year=1930}}</ref> In prostate cancer the cells of these prostate glands [[mutation|mutate]] into cancer cells. The prostate glands require male [[hormone]]s, known as [[androgen]]s, to work properly. Androgens include [[testosterone]], which is made in the [[testes]]; [[dehydroepiandrosterone]], made in the [[adrenal gland]]s; and [[dihydrotestosterone]], which is converted from testosterone within the prostate itself. Androgens are also responsible for [[secondary sex characteristic]]s such as facial hair and increased muscle mass.
* [http://www.amazon.com/gp/imdb/actor/nm0167585 Explore the work of Jim Coane at Amazon.com]
* [http://tv.yahoo.com/dragon-tales/show/30132/castcrew Dragon Tales cast and crew]
==Symptoms References ==
* {{cite news
Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated [[prostate specific antigen|PSA]] noticed during a routine checkup. Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as [[benign prostatic hypertrophy]]. These include [[urinary frequency|frequent urination]], [[nocturia|increased urination at night]], difficulty starting and maintaining a steady stream of urine, [[hematuria|blood in the urine]], and painful urination. Prostate cancer may also cause problems with sexual function, such as difficulty achieving [[erection]] or painful [[ejaculation]].<ref>{{cite journal| last=Miller| first=DC| coauthors=Hafez, KS, Stewart, A, et al| title=Prostate carcinoma presentation, diagnosis, and staging: an update form the National Cancer Data Base| journal=Cancer| year=2003| volume=98| pages=1169| id=PMID 12973840}}</ref>
|last=Coane
|first=Jim
|url=http://kidscreen.com/articles/magazine/19991001/26892.html
|title=Dragon Tales
|publisher=Kid Screen Magazine
|date=November,1999}}
==Trivia==
Advanced prostate cancer may cause additional symptoms as the disease spreads to other parts of the body. The most common symptom is [[bone pain]], often in the [[vertebrae]] (bones of the spine), [[pelvis]] or [[rib]]s, from cancer which has spread to these bones. Prostate cancer in the [[vertebral column|spine]] can also compress the [[spinal cord]], causing leg weakness and [[urinary incontinence|urinary]] and [[fecal incontinence]].<ref>{{cite journal| last=van der Cruijsen-Koeter| first=IW| coauthors=Vis AN, Roobol MJ, Wildhagen MF, de Koning HJ, van der Kwast TH, Schroder FH| title=Comparison of screen detected and clinically diagnosed prostate cancer in the European randomized study of screening for prostate cancer, section rotterdam| journal=Urol| year=2005| month=Jul| volume=174| issue=1| pages=121-5| id=PMID 15947595}}</ref>
* Coane's children, Max and Cassie, are the basis for two of the character's names in ''[[Dragon Tales]]''. His wife Amy is the namesake for Emmy, another character in the series.
==Pathophysiology==
[[Image:Normal cancer cell division from NIH.png|thumb|right|When normal cells are damaged beyond repair, they are eliminated by [[apoptosis]]. Cancer cells avoid apoptosis and continue to multiply in an unregulated manner.]]
Prostate cancer is classified as an [[adenocarcinoma]], or glandular cancer, that begins when normal semen-secreting prostate gland cells [[mutation|mutate]] into cancer cells. The region of prostate gland where the adenocarcinoma is most common is the peripheral zone. Initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, a condition known as [[carcinoma in situ]] or [[prostatic intraepithelial neoplasia]] (PIN). Although there is no proof that PIN is a cancer precursor, it is closely associated with cancer. Over time these cancer cells begin to multiply and spread to the surrounding prostate tissue (the [[stroma]]) forming a [[tumor]]. Eventually, the tumor may grow large enough to invade nearby organs such as the [[seminal vesicles]] or the [[rectum]], or the tumor cells may develop the ability to travel in the [[blood|bloodstream]] and [[lymphatic system]]. Prostate cancer is considered a [[malignant]] tumor because it is a mass of cells which can invade other parts of the body. This invasion of other organs is called [[metastasis]]. Prostate cancer most commonly metastasizes to the [[bone]]s, [[lymph node]]s, rectum, and bladder.
{{DEFAULTSORT:Coane, Jim}}
==Aetiology==
The specific causes of prostate cancer remain unknown.<ref>{{cite journal| first=Ann W.| last=Hsing| coauthors=Anand P. Chokkalingam| title=Prostate cancer epidemiology| journal=Frontiers in Bioscience| volume=11| pages=1388–1413| month=May 1| year=2006| url=http://www.bioscience.org/2006/v11/af/1891/fulltext.htm}}</ref> A man's risk of developing prostate cancer is related to his [[aging|age]], [[genetics]], [[race]], [[diet (nutrition)|diet]], [[lifestyle]], [[medication]]s, and other factors. The primary risk factor is age. Prostate cancer is uncommon in men less than 45, but becomes more common with advancing age. The average age at the time of diagnosis is 70.<ref>{{cite journal| last=Hankey| first=BF| coauthors=Feuer EJ, Clegg LX, Hayes RB, Legler JM, Prorok PC, Ries LA, Merrill RM, Kaplan RS| title=Cancer surveillance series: interpreting trends in prostate cancer—part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates| journal=J Natl Cancer Inst| year=1999| month=Jun 16| volume=91| issue=12| pages=1017–24| id=PMID 10379964}}</ref> However, many men never know they have prostate cancer. Autopsy studies of Chinese, German, Israeli, Jamaican, Swedish, and Ugandan men who died of other causes have found prostate cancer in thirty percent of men in their 50s, and in eighty percent of men in their 70s.<ref>{{cite journal| last=Breslow| first=N| coauthors=Chan CW, Dhom G, Drury RA, Franks LM, Gellei B, Lee YS, Lundberg S, Sparke B, Sternby NH, Tulinius H.| title=Latent carcinoma of prostate at autopsy in seven areas. The International Agency for Research on Cancer, Lyons, France| journal=Int J Cancer| year=1977| month=Nov 15| volume=20| issue=5| pages=680-8| id=PMID 924691}}</ref> In the year 2005 in the United States, there were an estimated 230,000 new cases of prostate cancer and 30,000 deaths due to prostate cancer.<ref>{{cite journal| last=Jemal A| coauthors=Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, Feuer EJ, Thun MJ| title=Cancer statistics, 2005| journal=CA Cancer J Clin| year=2005| month=Jan-Feb| volume=55| issue=1| pages=10–30| id=PMID 15661684}} Erratum in: CA Cancer J Clin. 2005 Jul-Aug;55(4):259</ref>
A man's genetic background contributes to his risk of developing prostate cancer. This is suggested by an increased [[incidence (epidemiology)|incidence]] of prostate cancer found in certain racial groups, in identical [[twin]]s of men with prostate cancer, and in men with certain [[gene]]s. In the United States, prostate cancer more commonly affects black men than white or Hispanic men, and is also more deadly in black men.<ref>{{cite journal| last=Hoffman| first=RM| coauthors=Gilliland FD; Eley JW; Harlan LC; Stephenson RA; Stanford JL; Albertson PC; Hamilton AS; Hunt WC; Potosky AL| title=Racial and ethnic differences in advanced-stage prostate cancer: the Prostate Cancer Outcomes Study| journal=J Natl Cancer Inst| year=2001| month=Mar 7| volume=93| issue=5| pages=388-95| id=PMID 11238701}}</ref> Men who have a brother or father with prostate cancer have twice the usual risk of developing prostate cancer.<ref>{{cite journal| last=Steinberg| first=GD| coauthors=Carter BS; Beaty TH; Childs B; Walsh PC| title=Family history and the risk of prostate cancer| journal=Prostate| year=1990| volume=17| issue=4| pages=337-47| id=PMID 2251225}}</ref> [[Twin study|Studies of twins]] in [[Scandinavia]] suggest that forty percent of prostate cancer risk can be explained by [[heritability|inherited factors]].<ref>{{cite journal| last=Lichtenstein| first=P| coauthors=Holm NV; Verkasalo PK; Iliadou A; Kaprio J; Koskenvuo M; Pukkala E; Skytthe A; Hemminki K| title=Environmental and heritable factors in the causation of cancer—analyses of cohorts of twins from Sweden, Denmark, and Finland| journal=N Engl J Med| year=2000| month=Jul 13| volume=343| issue=2| pages=78–85| id=PMID 10891514}}</ref> However, no single gene is responsible for prostate cancer; many different genes have been implicated. Two genes (''[[BRCA1]]'' and ''[[BRCA2]]'') that are important risk factors for [[ovarian cancer]] and [[breast cancer]] in women have also been implicated in prostate cancer.<ref>{{cite journal| last=Struewing| first=JP| coauthors=Hartge P; Wacholder S; Baker SM; Berlin M; McAdams M; Timmerman MM; Brody LC; Tucker MA| title=The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews| journal=N Engl J Med| year=1997| month=May 15| volume=336| issue=20| pages=1401–8| id=PMID 9145676}}</ref>
Dietary amounts of certain [[food]]s, [[vitamin]]s, and [[dietary mineral|minerals]] can contribute to prostate cancer risk. Men with higher serum levels of the short-chain [[Omega-3 fatty acid|ω-3 fatty acid]] [[Alpha-linolenic acid|linolenic acid]] have higher rates of prostate cancer. However, the same series of studies showed that men with elevated levels of long-chain ω-3 ([[eicosapentaenoic acid|EPA]] and [[docosahexaenoic acid|DHA]]) had lowered incidence.<ref>{{cite web|author=Gann, PH and Giovannucci|title=Prostate Cancer and Nutrition|year=2005|accessdate=February 20|accessyear=2006 |url= http://www.prostatecancerfoundation.org/atf/cf/%7B705B3273-F2EF-4EF6-A653-E15C5D8BB6B1%7D/Nutrition_Guide.pdf}} in .pdf format.</ref> A long-term study reports that "blood levels of trans fatty acids, in particular [[trans fats]] resulting from the hydrogenation of vegetable oils, are associated with an increased prostate cancer risk."<ref>Chavarro et al., "A prospective study of blood trans fatty acid levels and risk of prostate cancer," Proc. Amer. Assoc. Cancer Res., Volume 47, 2006 [http://www.aacrmeetingabstracts.org/cgi/content/abstract/2006/1/943]. See also [http://www.cancersupportivecare.com/nutritionprostate.pdf Ledesma 2004 Nutrition & prostate cancer].</ref> Other dietary factors that may increase prostate cancer risk include low intake of [[vitamin E]] (Vitamin E is found in [[green, leafy vegetables]]), [[lycopene]] (found in tomatoes), [[omega-3 fatty acid]]s (found in fatty fishes like [[salmon]]), and the mineral [[selenium]]. A study in 2007 cast doubt on the effectiveness of [[lycopene]] (found in tomatoes) in reducing the risk of prostate cancer<ref name='prostate_aacs'>{{cite news | first= | last=American Association for Cancer Research | coauthors= | title=No Magic Tomato? Study Breaks Link between Lycopene and Prostate Cancer Prevention | date=May 17, 2007 | publisher= | url =http://tools.wikimedia.de/~magnus/makeref.php | work = | pages = | accessdate = | language = }}</ref>.Lower [[blood]] levels of [[vitamin D]] also may increase the risk of developing prostate cancer. This may be linked to lower exposure to [[ultraviolet radiation|ultraviolet (UV) light]], since UV light exposure can increase vitamin D in the body.<ref>{{cite journal| last=Schulman| first=CC| coauthors=Ekane S; Zlotta AR| title=Nutrition and prostate cancer: evidence or suspicion?| journal=Urology| year=2001| month=Sep| volume=58| issue=3| pages=318-34| id=PMID 11549473}}</ref>
There are also some links between prostate cancer and medications, medical procedures, and medical conditions. Daily use of [[non-steroidal anti-inflammatory drugs|anti-inflammatory medicines]] such as [[aspirin]], [[ibuprofen]], or [[naproxen sodium|naproxen]] may decrease prostate cancer risk.<ref>{{cite journal| last=Jacobs| first=EJ| coauthors=Rodriguez C, Mondul AM, Connell CJ, Henley SJ, Calle EE, Thun MJ| title=A large cohort study of aspirin and other nonsteroidal anti-inflammatory drugs and prostate cancer incidence| journal=J Natl Cancer Inst| year=2005| month=Jul 6| volume=97| issue=13| pages=975-80| id=PMID 15998950}}</ref> Use of the [[hypolipidaemic agent|cholesterol-lowering drugs]] known as the [[statin]]s may also decrease prostate cancer risk.<ref>{{cite journal| last=Shannon| first=J| coauthors=Tewoderos S, Garzotto M, Beer TM, Derenick R, Palma A, Farris PE| title=Statins and prostate cancer risk: a case-control study| journal=Am J Epidemiol| year=2005| month=Aug 15| volume=162| issue=4| pages=318-25| id=PMID 16014776}} Epub 2005 Jul 13</ref> [[Sterilization (surgical procedure)|Sterilization]] by [[vasectomy]] may increase the risk of prostate cancer, though there are conflicting data.<ref>{{cite journal| last=Giovannucci| first=E| coauthors=Tosteson TD, Speizer FE, Ascherio A, Vessey MP, Colditz GA| title=A retrospective cohort study of vasectomy and prostate cancer in US men| journal=JAMA| year=1993| month=Feb 17| volume=269| issue=7| pages=878-82| id=PMID 8123059}}</ref> More frequent ejaculation also may decrease a man's risk of prostate cancer. One study showed that men who ejaculated five times a week in their 20s had a decreased rate of prostate cancer, though others have shown no benefit.<ref>{{cite journal| last=Giles| first=GG| coauthors=Severi G; English DR; McCredie MR; Borland R; Boyle P; Hopper JL| title=Sexual factors and prostate cancer| journal=BJU Int| year=2003| month= Aug| volume=92| issue=3| pages=211-6| id=PMID 12887469}}</ref><ref>{{cite journal| last= Leitzmann | first= Michael F. | Elizabeth A. Platz, ScD; Meir J. Stampfer, MD; Walter C. Willett, MD; Edward Giovannucci, MD | title= Ejaculation Frequency and Subsequent Risk of Prostate Cancer | journal= JAMA | year= 2004 | month= April 7 | volume= 291 | issue= 13 | pages= 1578–86|id= 2004;291:1578-1586}}[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=15069045&query_hl=2&itool=pubmed_docsum| PMID: 15069045]</ref> [[Infection]] or [[inflammation]] of the prostate ([[prostatitis]]) may increase the chance for prostate cancer. In particular, infection with the [[sexually transmitted infection]]s [[chlamydia]], [[gonorrhea]], or [[syphilis]] seems to increase risk.<ref>{{cite journal| last=Dennis| first=LK| coauthors=Lynch CF; Torner JC| title=Epidemiologic association between prostatitis and prostate cancer| journal=Urology| year=2002| month=Jul| volume=60| issue=1| pages=78–83| id=PMID 12100928}}</ref>
Finally, [[obesity]]<ref>{{cite journal| last=Calle| first= EE| coauthors=Rodriguez C, Walker-Thurmond K, Thun MJ| title=Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults| journal=N Engl J Med| year=2003 | month=Apr 24| volume=348| issue=17| pages=1625–38| id=PMID 12711737}}</ref>
and elevated blood levels of [[testosterone]]<ref>{{cite journal| last=Gann| first= PH| coauthors=Hennekens CH, Ma J, Longcope C, Stampfer MJ| title=Prospective study of sex hormone levels and risk of prostate cancer| journal=J Natl Cancer Inst| year=1996| month=Aug 21| volume=88| issue=16| pages=1118–26| id=PMID 8757191}}</ref>
may increase the risk for prostate cancer.
Research released in May 2007, found that US war veterans who had been exposed to [[Agent Orange]] had a 48% increased risk of prostate cancer recurrence following surgery<ref name='aorange'> {{cite web|url=https://my.mcg.edu/portal/page/portal/News/archive/2007/Veterans%20exposed%20to%20Agent%20%20Orange%20have%20higher%20rates%20of%20prost |title=Veterans exposed to Agent Orange have higher rates of prostate cancer recurrence |date=May 20, 2007 |work=Medical College of Georgia News }}</ref>.
Prostate cancer risk can be decreased by modifying known risk factors for prostate cancer, such as decreasing intake of animal fat.<ref>{{cite journal | author= | title=Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets | journal=J Am Diet Assoc | year=2003 | pages=748-65 | volume=103 | issue=6 | id=PMID 12778049}}</ref>
==Prevention==
Several medications and vitamins may also help prevent prostate cancer. Two dietary supplements, [[vitamin E]] and [[selenium]], may help prevent prostate cancer when taken daily. Estrogens from fermented [[soybeans]] and other plant sources (called [[phytoestrogen]]s) may also help prevent prostate cancer.<ref>{{cite journal| last=Strom| first= SS| coauthors=Yamamura Y, Duphorne CM, Spitz MR, Babaian RJ, Pillow PC, Hursting SD| title=Phytoestrogen intake and prostate cancer: a case-control study using a new database| journal=Nutr Cancer| year=1999| volume=33| issue=1| pages=20-5| id=PMID 10227039}} Erratum in: Nutr Cancer 2000;36(2):243.</ref> The [[selective estrogen receptor modulator]] drug [[toremifene]] has shown promise in early trials.<ref>{{cite journal| last=Steiner| first=MS| coauthors=Pound, CR, Gingrich, JR, et al.| title=Acapodene (GTx-006) reduces high-grade prostatic intraepithelial neoplasia in phase II clinical trial (abstract)| journal=Proc Am Soc Clin Oncol| year=2002| volume=21| pages=180a}}</ref><ref>{{cite journal| last=Price| first= D| coauthors=Stein, B, Goluboff, E, et al.| title=Double-blind, placebo-controlled trial of toremifene for the provention of prostate cancer in men with high-grade prostatic intrapeithelial neoplasia (abstract)| journal=J Clin Oncol| year=2005| volume=23| pages=106s}}</ref>
Two medications which block the conversion of [[testosterone]] to [[dihydrotestosterone]], [[finasteride]]<ref>{{cite journal| last=Thompson| first=IM| coauthors=Goodman PJ, Tangen CM, Lucia MS, Miller GJ, Ford LG, Lieber MM, Cespedes RD, Atkins JN, Lippman SM, Carlin SM, Ryan A, Szczepanek CM, Crowley JJ, Coltman CA Jr.| title=The influence of finasteride on the development of prostate cancer| journal=N Engl J Med| year=2003| month=Jul 17| volume=349| issue=3| pages=215-24| id=PMID 12824459}}</ref>
and [[dutasteride]],<ref>{{cite journal| last=Andriole| first=GL| coauthors=Roehrborn C, Schulman C, Slawin KM, Somerville M, Rittmaster RS| title=Effect of dutasteride on the detection of prostate cancer in men with benign prostatic hyperplasia| journal=Urology| year=2004| month=Sep| volume=64| issue=3| pages=537–41; discussion 542-3| id=PMID 15351586}}</ref> have also shown some promise. [[As of 2006]] the use of these medications for primary prevention is still in the testing phase, and they are not widely used for this purpose. The problem with these medications is that they may preferentially block the development of lower-grade prostate tumors, leading to a relatively greater chance of higher grade cancers, and negating any overall survival improvement.
[[Green tea]] may be protective (due to its [[polyphenol]] content), though the data are mixed.<ref>Lee AH, Fraser ML, Meng X, Binns CW. ''Protective effects of green tea against prostate cancer.'' Expert Rev Anticancer Ther. 2006 Apr;6(4):507-13. Review. PMID 16613539</ref><ref>Kikuchi N, Ohmori K, Shimazu T, Nakaya N, Kuriyama S, Nishino Y, Tsubono Y, Tsuji I. ''No association between green tea and prostate cancer risk in Japanese men: the Ohsaki Cohort Study.'' Br J Cancer. 2006 Aug 7;95(3):371-3. Epub 2006 Jun 27. PMID 16804523 </ref>
A 2006 study of green tea derivatives demonstrated promising prostate cancer prevention in patients at high risk for the disease.<ref>{{cite journal |author=Bettuzzi S, Brausi M, Rizzi F, Castagnetti G, Peracchia G, Corti A |title=Chemoprevention of human prostate cancer by oral administration of green tea catechins in volunteers with high-grade prostate intraepithelial neoplasia: a preliminary report from a one-year proof-of-principle study |journal=Cancer Res |volume=66 |issue=2 |pages=1234–40 |year=2006 |pmid=16424063}}</ref> In 2003, an Australian research team led by Graham Giles of The Cancer Council Australia concluded that frequent [[masturbation]] by males appears to help prevent the development of prostate cancer.<ref>http://news.bbc.co.uk/1/hi/health/3072021.stm</ref>
Recent research published in the Journal of the [[National Cancer Institute]] suggests that taking [[multivitamins]] more than seven times a week can increase the risks of contracting the disease.<ref>http://news.bbc.co.uk/1/hi/health/6657795.stm</ref> Scientists recommend a healthy, well balanced diet rich in fiber, and to reduce intake of meat. This reseach was unable to highlight the exact vitamins responsible for this increase (almost double), although they suggest that vitamin A, vitamin E and beta-carotene may lie at its heart. It is advised that those taking multivitamins never exceed the stated daily dose on the label.
==Screening==
{{main|Prostate cancer screening}}
Prostate cancer [[screening (medicine)|screening]] is an attempt to find unsuspected cancers. Screening tests may lead to more specific follow-up tests such as a [[biopsy]], where small pieces of the prostate are removed for closer study. [[As of 2006]] prostate cancer screening options include the [[Rectal examination|digital rectal exam]] and the [[prostate specific antigen]] (PSA) blood test. Screening for prostate cancer is controversial because it is not clear if the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments.
Prostate cancer is a slow-growing cancer, very common among older men. In fact, most prostate cancers never grow to the point where they cause symptoms, and most men with prostate cancer die of other causes before prostate cancer has an impact on their lives. The PSA screening test may detect these small cancers that would never become life threatening. Doing the PSA test in these men may lead to [[overdiagnosis]], including additional testing and treatment. Follow-up tests, such as [[prostate biopsy]], may cause pain, bleeding and infection. Prostate cancer treatments may cause urinary [[Urinary incontinence|incontinence]] and [[erectile dysfunction]]. Therefore, it is essential that the risks and benefits of diagnostic procedures and treatment be carefully considered before PSA screening.
Prostate cancer screening generally begins after age fifty, but may be offered earlier in black men or men with a strong family history of prostate cancer.<ref>{{cite journal| last=Grubb| first=RL| coauthors=Roehl KA, Antenor JA, Catalona WJ| title=Results of compliance with prostate cancer screening guidelines| journal=J Urol| year=2005| month= Aug| volume=174| issue=2| pages=668–72; discussion 672| id=PMID 16006944}}</ref> The American Academy of Family Physicians and American College of Physicians recommend the physician discuss the risks and benefits of screening and decide based on individual patient preference.<ref name=healtham>{{cite web | author = Joseph C. Presti, Jr, MD | title =Prostate Cancer - Screening for Prostate Cancer | work =Prostate Cancer | url=http://www.health.am/cr/prostate-cancer/ | year = 2006 | publsiher=Armenian Health Network, Health.am | accessdate=2007-02-26}}</ref> Although there is no officially recommended cutoff, many health care providers stop monitoring PSA in men who are older than 75 years old because of concern that prostate cancer therapy may do more harm than good as age progresses and life expectancy decreases.
===Digital rectal examination===
[[Rectal examination|Digital rectal examination]] (DRE) is a procedure where the examiner inserts a gloved, lubricated finger into the rectum to check the size, shape, and texture of the prostate. Areas which are irregular, hard or lumpy need further evaluation, since they may contain cancer. Although the DRE only evaluates the back of the prostate, 85% of prostate cancers arise in this part of the prostate. Prostate cancer which can be felt on DRE is generally more advanced.<ref>{{cite journal| last=Chodak| first=GW| coauthors=Keller P, Schoenberg HW| title=Assessment of screening for prostate cancer using the digital rectal examination| journal=J Urol| year=1989| month=May| volume=141| issue=5| pages=1136–8| id=PMID 2709500}}</ref> The use of DRE has never been shown to prevent prostate cancer deaths when used as the only screening test.<ref>{{cite journal| last=Krahn| first=MD| coauthors=Mahoney JE, Eckman MH, Trachtenberg J, Pauker SG, Detsky AS| title=Screening for prostate cancer.. A decision analytic view| journal=JAMA| year=1994| month=Sep 14| volume=272| issue=10| pages=773-80| id=PMID 7521400}}</ref>
===Prostate specific antigen===
{{main|Prostate specific antigen}}
The PSA test measures the blood level of [[prostate-specific antigen]], an [[enzyme]] produced by the prostate. Specifically, PSA is a [[serine protease]] similar to [[kallikrein]]. Its normal function is to liquify gelatinous semen after ejaculation, allowing [[spermatazoa]] to more easily "swim" through the uterine [[cervix]].
PSA levels under 4 ng/mL ([[nanogram]]s per [[milliliter]]) are generally considered normal, while levels over 4 ng/mL are considered abnormal (although in men over 65 levels up to 6.5 ng/mL may be acceptable, depending upon each laboratory's reference ranges). PSA levels between 4 and 10 ng/mL indicate a risk of prostate cancer higher than normal, but the risk does not seem to rise within this six-point range. When the PSA level is above 10 ng/mL, the association with cancer becomes stronger. However, PSA is not a perfect test. Some men with prostate cancer do not have an elevated PSA, and most men with an elevated PSA do not have prostate cancer.
PSA levels can change for many reasons other than cancer. Two common causes of high PSA levels are enlargement of the prostate ([[benign prostatic hypertrophy]] (BPH)) and infection in the prostate ([[prostatitis]]). It can also be raised for 24 hours after ejaculation and several days after catheterization. PSA levels are lowered in men who use medications used to treat BPH or [[baldness]]. These medications, [[finasteride]] (marketed as Proscar or Propecia) and [[dutasteride]] (marketed as Avodart), may decrease the PSA levels by 50% or more.
Several other ways of evaluating the PSA have been developed to avoid the shortcomings of simple PSA screening.. The use of age-specific reference ranges improves the sensitivity and specificity of the test. The rate of rise of the PSA over time, called the PSA velocity, has been used to evaluate men with PSA levels between 4 and 10 ng/ml, but [[as of 2006]], it has not proven to be an effective screening test.<ref>{{cite journal| last=Roobol| first=MJ| coauthors=Kranse R, de Koning HJ, Schroder FH| title=Prostate-specific antigen velocity at low prostate-specific antigen levels as screening tool for prostate cancer: results of second screening round of ERSPC (ROTTERDAM)| journal=Urology| year=2004| month=Feb| volume=63| issue=2| pages=309–13; discussion 313-5| id=PMID 14972478}}</ref> Comparing the PSA level with the size of the prostate, as measured by [[Medical ultrasonography|ultrasound]] or [[magnetic resonance imaging]], has also been studied. This comparison, called PSA density, is both costly and, [[as of 2006]], has not proven to be an effective screening test.<ref>{{cite journal| last=Catalona| first=WJ| coauthors=Richie JP, deKernion JB, Ahmann FR, Ratliff TL, Dalkin BL, Kavoussi LR, MacFarlane MT, Southwick PC| title=Comparison of prostate specific antigen concentration versus prostate specific antigen density in the early detection of prostate cancer: receiver operating characteristic curves| journal=J Urol| year=1994| month=Dec| volume=152| issue=6 Pt 1| pages=2031–6| id=PMID 7525994}}</ref> PSA in the blood may either be free or bound to other [[protein]]s. Measuring the amount of PSA which is free or bound may provide additional screening information, but [[as of 2006]], questions regarding the usefulness of these measurements limit their widespread use.<ref>{{cite journal| last=Hoffman| first=RM| coauthors=Clanon DL, Littenberg B, Frank JJ, Peirce JC| title=Using the free-to-total prostate-specific antigen ratio to detect prostate cancer in men with nonspecific elevations of prostate-specific antigen levels| journal=J Gen Intern Med| year=2000| month=Oct| volume=15| issue=10| pages=739-48| id=PMID 11089718}}</ref><ref>{{cite journal| last=Partin| first=AW| coauthors=Brawer MK; Bartsch G; Horninger W; Taneja SS; Lepor H; Babaian R; Childs SJ; Stamey T; Fritsche HA; Sokoll L; Chan DW; Thiel RP; Cheli CD| title=Complexed prostate specific antigen improves specificity for prostate cancer detection: results of a prospective multicenter clinical trial| journal=J Urol| year=2003| month=Nov| volume=170| issue=5| pages=1787–91| id=PMID 14532777}}</ref>
==Diagnosis==
[[Image:Prostatehistopath.jpg|thumb|right|500px|'''Normal prostate (A) and prostate cancer (B).''' In prostate cancer, the regular glands of the normal prostate are replaced by irregular glands and clumps of cells, as seen in these pictures taken through a microscope.]]
When a man has symptoms of prostate cancer, or a screening test indicates an increased risk for cancer, more invasive evaluation is offered. The only test which can fully confirm the diagnosis of prostate cancer is a [[biopsy]], the removal of small pieces of the prostate for microscopic examination. However, prior to a biopsy, several other tools may be used to gather more information about the prostate and the urinary tract. [[Cystoscopy]] shows the urinary tract from inside the bladder, using a thin, flexible camera tube inserted down the [[urethra]]. [[Transrectal ultrasonography]] creates a picture of the prostate using sound waves from a probe in the rectum.
If cancer is suspected, a biopsy is offered. During a biopsy a [[urology|urologist]] obtains tissue samples from the prostate via the rectum. A biopsy gun inserts and removes special hollow-core needles (usually three to six on each side of the prostate) in less than a second. The tissue samples are then examined under a microscope to determine whether cancer cells are present, and to evaluate the microscopic features (or [[Gleason score]]) of any cancer found. Prostate biopsies are routinely done on an outpatient basis and rarely require hospitalization. Fifty-five percent of men report discomfort during prostate biopsy.<ref>{{cite journal| last=Essink-Bot| first=ML| coauthors=de Koning HJ, Nijs HG, Kirkels WJ, van der Maas PJ, Schroder FH| title=Short-term effects of population-based screening for prostate cancer on health-related quality of life| journal=J Natl Cancer Inst| year=1998| month=Jun 17| volume=90| issue=12| pages=925-31| id=PMID 9637143}}</ref>
Currently, an active area of research involves non-invasive methods of prostate tumor detection. Adenoviruses modified to transfect tumor cells with harmless yet distinct genes (such as luciferase) have proven capable of early detection. So far, though, this area of research has only been tested in animal and [[LNCaP]] models.<ref>Iyer M, Salazar FB, Lewis X, Zhang L, Wu L, Carey M and Gambhir SS. Non-invasive imaging of a transgenic mouse model using a prostate-specific two-step transcriptional amplification strategy. Transg Res.2005; 14(1): 47–55</ref>
Another potential non-invasive methods of early prostate tumor detection is through a molecular test that detects the presence of cell-associated [[PCA3]] mRNA in urine. [[PCA3]] mRNA is expressed almost exclusively by prostate cells and has been shown to be highly over-expressed in prostate cancer cells.
It was reported in [[April]] [[2007]] that a new blood test for [[early prostate cancer antigen-2]] (EPCA-2) is being researched that may alert men if they have prostate cancer and how aggressive it will be.<ref>[http://www.msnbc.msn.com/id/18328032/site/newsweek/ A Prostate Cancer Revolution]. Newsweek, [[April 26]], [[2007]].</ref>
==Staging==
{{main|Prostate cancer staging}}
An important part of evaluating prostate cancer is determining the [[cancer staging|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 node]]s, and the presence of any other [[metastasis|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. These include [[computed tomography]] to evaluate spread within the pelvis, [[bone scan]]s to look for spread to the bones, and [[endorectal coil magnetic resonance imaging]] to closely evaluate the prostatic capsule and the [[seminal vesicles]]. Bone scans should reveal osteoblastic appearance due to ''increased'' bone density in the areas of bone metastisis - opposite to what is found in many other cancers that metastisize.
After a prostate biopsy, a [[pathology|pathologist]] looks at the samples under a microscope. If cancer is present, the pathologist reports the [[Grading (tumors)|grade]] of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue and suggests how fast the tumor is likely to grow. The Gleason system is used to grade prostate tumors from 2 to 10, where a [[Gleason score]] of 10 indicates the most abnormalities. The pathologist assigns a number from 1 to 5 for the most common pattern observed under the microscope, then does the same for the second most common pattern. The sum of these two numbers is the Gleason score. The [[Whitmore-Jewett stage]] is another method sometimes used. Proper grading of the tumor is critical, since the grade of the tumor is one of the major factors used to determine the treatment recommendation.
==Risk assessment==
Many prostate cancers are not destined to be lethal, and most men will ultimately die from causes other than of the disease. Decisions about treatment type and timing may therefore be informed by an estimation of the '''risk''' that the tumor will ultimately recur after treatment and/or progress to metastases and mortality. Several tools are available to help predict outcomes such as pathologic stage and recurrence after surgery or radiation therapy. Most combine stage, grade, and PSA level, and some also add the number or percent of biopsy cores positive, age, and/or other information.
The D’Amico classification stratifies men to low, intermediate, or high risk based on stage, grade, and PSA. It is used widely in clinical practice and research settings. The major downside to the 3-level system is that it does not account for multiple adverse parameters (e.g., high Gleason score ''and'' high PSA) in stratifying patients.
The Partin tables predict pathologic outcomes (margin status, extraprostatic extension, and seminal vesicle invasion) based on the same 3 variables, and are published as lookup tables.
The Kattan nomograms predict recurrence after surgery and/or radiation therapy, based on data available either at time of diagnosis or after surgery. The nomograms can be calculated using paper graphs, or using software available on a website or for handheld computers. The Kattan score represents the likelihood of remaining free of disease at a given time interval following treatment.
The [http://urology.ucsf.edu UCSF] Cancer of the Prostate Risk Assessment (CAPRA) score predicts both pathologic status and recurrence after surgery. It offers comparable accuracy as the Kattan preoperative nomogram, and can be calculated without paper tables or a calculator. Points are assigned based on PSA, Grade, stage, age, and percent of cores positive; the sum yields a 0–10 score, with every 2 points representing roughly a doubling of risk of recurrence. The CAPRA score was derived from community-based data in the [http://www.capsure.net CaPSURE] database.
==Treatment==
Treatment for prostate cancer may involve [[watchful waiting]], [[surgery]], [[radiation therapy]], [[High Intensity Focused Ultrasound (HIFU)]], [[chemotherapy]], [[cryosurgery]], hormonal therapy, or some combination. Which option is best depends on the stage of the disease, the Gleason score, and the PSA level. Other important factors are the man's age, his general health, and his feelings about potential treatments and their possible side effects. Because all treatments can have significant [[Adverse effect (medicine)|side effect]]s, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations.
If the cancer has spread beyond the prostate, treatment options significantly change, so most doctors who treat prostate cancer use a variety of [[nomogram]]s to predict the probability of spread. Treatment by watchful waiting, HIFU, radiation therapy, cryosurgery, and surgery are generally offered to men whose cancer remains within the prostate. Hormonal therapy and chemotherapy are often reserved for disease which has spread beyond the prostate. However, there are exceptions: radiation therapy may be used for some advanced tumors, and hormonal therapy is used for some early stage tumors. [[Cryotherapy]], hormonal therapy, and chemotherapy may also be offered if initial treatment fails and the cancer progresses.
===Watchful waiting and active surveillance===
[[Watchful waiting]], also called "active surveillance," refers to observation and regular monitoring without invasive treatment. Watchful waiting is often used when an early stage, slow-growing prostate cancer is found in an older man. Watchful waiting may also be suggested when the risks of surgery, radiation therapy, or hormonal therapy outweigh the possible benefits. Other treatments can be started if symptoms develop, or if there are signs that the cancer growth is accelerating (e.g., rapidly rising PSA, increase in Gleason score on repeat biopsy, etc.). Most men who choose watchful waiting for early stage tumors eventually have signs of tumor progression, and they may need to begin treatment within three years.<ref>{{cite journal| last=Wu| first=H| coauthors=Sun L, Moul JW, Wu HY, McLeod DG, Amling C, Lance R, Kusuda L, Donahue T, Foley J, Chung A, Sexton W, Soderdahl D| title=Watchful waiting and factors predictive of secondary treatment of localized prostate cancer| journal=J Urol| year=2004| month=Mar| volume=171| issue=3| pages=1111–6| id=PMID 14767282}}</ref> Although men who choose watchful waiting avoid the risks of surgery and radiation, the risk of metastasis (spread of the cancer) may be increased. For younger men, a trial of active surveillance may not mean avoiding treatment altogether, but may reasonably allow a delay of a few years or more, during which time the quality of life impact of active treatment can be avoided. Published data to date suggest that carefully selected men will not miss a window for cure with this approach. Additional health problems that develop with advancing age during the observation period can also make it harder to undergo surgery and radiation therapy.
===Surgery===
Surgical removal of the prostate, or [[prostatectomy]], is a common treatment either for early stage prostate cancer, or for cancer which has failed to respond to radiation therapy. The most common type is [[radical retropubic prostatectomy]], when the surgeon removes the prostate through an abdominal incision. Another type is [[radical perineal prostatectomy]], when the surgeon removes the prostate through an incision in the [[perineum]], the skin between the [[scrotum]] and [[anus]]. Radical prostatectomy can also be performed laparoscopically, through a series of small (1cm) incisions in the abdomen, with or without the assistance of a surgical robot.
[[Radical prostatectomy]] is highly effective for tumors which have not spread beyond the prostate; cure rates depend on risk factors such as PSA level and Gleason grade. However, it may cause [[nerve]] damage that significantly alters the quality of life of the prostate cancer survivor. The most common serious complications are loss of [[urinary incontinence|urinary control]] and [[impotence]]. Reported rates of both complications vary widely depending on how they are assessed, by whom, and how long after surgery, as well as the setting (e.g., academic series vs. community-based or population-based data). Although penile sensation and the ability to achieve [[orgasm]] usually remain intact, erection and ejaculation are often impaired. Medications such as [[sildenafil]] (Viagra), [[tadalafil]] (Cialis), or [[vardenafil]] (Levitra) may restore some degree of potency. For most men with organ-confined disease, a more limited "nerve-sparing" technique may help avoid urinary incontinence and impotence.<ref>{{cite journal| last=Gerber| first=GS| coauthors=Thisted RA, Scardino PT, Frohmuller HG, Schroeder FH, Paulson DF, Middleton AW Jr, Rukstalis DB, Smith JA Jr, Schellhammer PF, Ohori M, Chodak GW| title=Results of radical prostatectomy in men with clinically localized prostate cancer| journal=JAMA| year=1996| month=Aug 28| volume=276| issue=8| pages=615-9| id=PMID 8773633}}</ref>
Radical prostatectomy has traditionally been used alone when the cancer is small. In the event of positive margins or locally advanced disease found on pathology, adjuvant radiation therapy may offer improved survival. Surgery may also be offered when a cancer is not responding to radiation therapy. However, because radiation therapy causes tissue changes, prostatectomy after radiation has a higher risk of complications.
[[Transurethral resection of the prostate]], commonly called a "TURP," is a surgical procedure performed when the tube from the bladder to the penis ([[urethra]]) is blocked by prostate enlargement. TURP is generally for benign disease and is not meant as definitive treatment for prostate cancer. During a TURP, a small tube ([[cystoscope]]) is placed into the penis and the blocking prostate is cut away.
In metastatic disease, where cancer has spread beyond the prostate, removal of the [[testicle]]s (called [[orchiectomy]]) may be done to decrease testosterone levels and control cancer growth. (See hormonal therapy, below).
===Radiation therapy===
[[Image:brachytherapy.jpg|thumb|left|250px|'''[[Brachytherapy]]''' for prostate cancer is administered using "seeds," small radioactive rods implanted directly into the tumor.]][[Radiation therapy]], also known as radiotherapy, uses [[ionizing radiation]] to kill prostate cancer cells. When absorbed in tissue, [[Ionizing radiation]] such as Gamma and x-rays damage the [[DNA]] in cells, which increases the probability of apoptosis (cell death). Two different kinds of radiation therapy are used in prostate cancer treatment: [[external beam radiotherapy|external beam radiation therapy]] and [[brachytherapy]].
External beam radiation therapy uses a [[linear accelerator]] to produce high-energy x-rays which are directed in a beam towards the prostate. A technique called Intensity Modulated Radiation Therapy (IMRT) may be used to adjust the radiation beam to conform with the shape of the tumor, allowing higher doses to be given to the prostate and seminal vesicles with less damage to the bladder and rectum. External beam radiation therapy is generally given over several weeks, with daily visits to a radiation therapy center. New types of radiation therapy may have fewer side effects then traditional treatment, one of these is [[Tomotherapy]].
[[Image:linacprostate.jpg|thumb|right|150px|[[External beam radiotherapy|External beam radiation therapy]] for prostate cancer is delivered by a linear accelerator, such as this one.]]
Permanent implant brachytherapy is a popular treatment choice for patients with low to intermediate risk features, can be performed on an outpatient basis, and is associated with good 10-year outcomes with relatively low morbidity<ref>{{cite journal| last=Nag| first=S| coauthors=Beyer D, Friedland J, Grimm P, Nath R| title=American Brachytherapy Society Recommendations for Transperineal Permanent Brachytherapy of Prostate Cancer | journal=Int. J. Rad. Onc. Biol. Phys. | year=1999| month=?| volume=44| issue=4| pages=789–799| id=?}} Review.</ref> It involves the placement of about 100 small "seeds" containing radioactive material (such as [[iodine-125]] or [[palladium-103]]) with a needle through the skin of the [[perineum]] directly into the tumor while under spinal or general anesthetic. These seeds emit [[Superficial X-ray|lower-energy X-rays]] which are only able to travel a short distance. Although the seeds eventually become inert, they remain in the prostate permanently. The risk of exposure to others from men with implanted seeds is generally accepted to be insignificant.<ref>{{cite journal| last=Perez| first=CA| coauthors=Hanks GE, Leibel SA, Zietman AL, Fuks Z, Lee WR| title=Localized carcinoma of the prostate (stages T1B, T1C, T2, and T3). Review of management with external beam radiation therapy| journal=Cancer| year=1993| month=Dec 1| volume=72| issue=11| pages=3156–73| id=PMID 7694785}} Review.</ref>
Radiation therapy is commonly used in prostate cancer treatment. It may be used instead of surgery for early cancers, and it may also be used in advanced stages of prostate cancer to treat painful bone metastases. Radiation treatments also can be combined with hormonal therapy for intermediate risk disease, when radiation therapy alone is less likely to cure the cancer. Some radiation oncologists combine external beam radiation and brachytherapy for intermediate to high risk situations. One study found that the combination of six months of androgen suppressive therapy combined with external beam radiation had improved survival compared to radiation alone in patients with localized prostate cancer.<ref>{{cite journal | author=D'Amico AV, Manola J, Loffredo M, Renshaw AA, DellaCroce A, Kantoff PW | title=6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial | journal=JAMA | year=2004 | pages=821-7 | volume=292 | issue=7 | id=PMID 15315996}}</ref> Others use a "triple modality" combination of external beam radiation therapy, brachytherapy, and hormonal therapy.
Less common applications for radiotherapy are when cancer is compressing the spinal cord, or sometimes after surgery, such as when cancer is found in the seminal vesicles, in the lymph nodes, outside the prostate capsule, or at the margins of the biopsy.
Radiation therapy is often offered to men whose medical problems make surgery more risky. Radiation therapy appears to cure small tumors that are confined to the prostate just about as well as surgery. However, [[as of 2006]] some issues remain unresolved, such as whether radiation should be given to the rest of the pelvis, how much the [[absorbed dose]] should be, and whether hormonal therapy should be given at the same time.
Side effects of radiation therapy might occur after a few weeks into treatment. Both types of radiation therapy may cause [[diarrhea]] and [[Gastrointestinal bleeding|rectal bleeding]] due to [[radiation proctitis]], as well as urinary incontinence and impotence. Symptoms tend to improve over time.<ref>{{cite journal| last=Lawton| first=CA| coauthors=Won M, Pilepich MV, Asbell SO, Shipley WU, Hanks GE, Cox JD, Perez CA, Sause WT, Doggett SR, et al| title=Long-term treatment sequelae following external beam irradiation for adenocarcinoma of the prostate: analysis of RTOG studies 7506 and 7706| journal=Int J Radiat Oncol Biol Phys| year=1991| month=Sep| volume=21| issue=4| pages=935-9| id=PMID 1917622}}</ref> Men who have undergone external beam radiation therapy will have a higher risk of later developing [[colon cancer]] and [[bladder cancer]].<ref>{{cite journal| last=Brenner| first=DJ| coauthors=Curtis RE, Hall EJ, Ron E| title=Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery| journal=Cancer| year=2000| month=Jan 15| volume=88| issue=2| pages=398–406| id=PMID 10640974}}</ref>
===Cryosurgery===
[[Cryosurgery]] is another method of treating prostate cancer. It is less invasive than radical prostatectomy, and [[general anesthesia]] is less commonly used. Under ultrasound guidance, a method invented by Dr. [[Gary Onik]],<ref>{{cite web | title=Cryosurgical system for destroying tumors by freezing | url=http://www.patentstorm.us/patents/5334181.html | accessdate= 1994-08-02}}</ref> metal rods are inserted through the skin of the [[perineum]] into the prostate. Highly purified Argon gas is used to cool the rods, freezing the surrounding tissue at −196 °[[celsius|C]] (−320 °[[Fahrenheit|F]]). As the water within the prostate cells freeze, the cells die. The [[urethra]] is protected from freezing by a [[Foley catheter|catheter]] filled with warm liquid. Cryosurgery generally causes fewer problems with urinary control than other treatments, but impotence occurs up to ninety percent of the time. When used as the initial treatment for prostate cancer, cryosurgery is not as effective as surgery or radiation.<ref>{{cite journal| last=Bahn| first=DK| coauthors=Lee F, Badalament R, Kumar A, Greski J, Chernick M| title=Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer| journal=Urology| year=2002| month=Aug| volume=60| issue=2 Suppl 1| pages=3–11| id=PMID 12206842}}</ref> However, cryosurgery is potentially better than radical prostatectomy for recurrent cancer following radiation therapy.
===Hormonal therapy===
[[image:prostatehormone.jpg|right|thumb|200px|'''Hormonal therapy in prostate cancer.''' Diagram shows the different organs (''purple text''), hormones (''black text and arrows''), and treatments (''red text and arrows'') important in hormonal therapy.]]
[[Hormone therapy|Hormonal therapy]] uses medications or surgery to block prostate cancer cells from getting [[dihydrotestosterone]] (DHT), a hormone produced in the prostate and required for the growth and spread of most prostate cancer cells. Blocking DHT often causes prostate cancer to stop growing and even shrink. However, hormonal therapy rarely cures prostate cancer because cancers which initially respond to hormonal therapy typically become resistant after one to two years. Hormonal therapy is therefore usually used when cancer has spread from the prostate. It may also be given to certain men undergoing radiation therapy or surgery to help prevent return of their cancer.<ref>{{cite journal| last=Robson| first=M| coauthors=Dawson N| title=How is androgen-dependent metastatic prostate cancer best treated?| journal=Hematol Oncol Clin North Am| year=1996| month=Jun| volume=10| issue=3| pages=727-47| id=PMID 8773508}} Review.</ref>
Hormonal therapy for prostate cancer targets the pathways the body uses to produce DHT. A [[feedback loop]] involving the testicles, the hypothalamus, and the pituitary, adrenal, and prostate glands controls the blood levels of DHT. First, low blood levels of DHT stimulate the [[hypothalamus]] to produce [[gonadotropin releasing hormone]] (GnRH). GnRH then stimulates the [[pituitary gland]] to produce [[luteinizing hormone]] (LH), and LH stimulates the [[testicles]] to produce testosterone. Finally, testosterone from the testicles and dehydroepiandrosterone from the [[adrenal gland]]s stimulate the prostate to produce more DHT. Hormonal therapy can decrease levels of DHT by interrupting this pathway at any point.
There are several forms of hormonal therapy:
*[[Castration|Orchiectomy]] is surgery to remove the testicles. Because the testicles make most of the body's testosterone, after orchiectomy testosterone levels drop. Now the prostate not only lacks the testosterone stimulus to produce DHT, but also it does not have enough testosterone to transform into DHT.
*[[Antiandrogens]] are medications such as [[flutamide]], [[bicalutamide]], [[nilutamide]], and [[cyproterone acetate]] which directly block the actions of testosterone and DHT within prostate cancer cells.
*Medications which block the production of adrenal androgens such as DHEA include [[ketoconazole]] and [[aminoglutethimide]]. Because the adrenal glands only make about 5% of the body's androgens, these medications are generally used only in combination with other methods that can block the 95% of androgens made by the testicles. These combined methods are called total androgen blockade (TAB). TAB can also be achieved using antiandrogens.
*GnRH action can be interrupted in one of two ways. [[Gonadotropin-releasing hormone analog|GnRH antagonists]] suppress the production of LH directly, while [[Gonadotropin-releasing hormone analog|GnRH agonists]] suppress LH through the process of [[downregulation]] after an initial stimulation effect. [[Abarelix]] is an example of a GnRH antagonist, while the GnRH agonists include [[leuprolide]], [[goserelin]], [[triptorelin]], and [[buserelin]]. Initially, GnRH agonists ''increase'' the production of LH. However, because the constant supply of the medication does not match the body's natural production rhythm, production of both LH and GnRH decreases after a few weeks.<ref>{{cite journal| last=Loblaw| first=DA| coauthors=Mendelson DS, Talcott JA, Virgo KS, Somerfield MR, Ben-Josef E, Middleton R, Porterfield H, Sharp SA, Smith TJ, Taplin ME, Vogelzang NJ, Wade JL Jr, Bennett CL, Scher HI; American Society of Clinical Oncology| title=American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer| journal=J Clin Oncol| year=2004| month=Jul 15| volume=22| issue=14| pages=2927–41| id=PMID 15184404}} Erratum in: J Clin Oncol. 2004 Nov 1;22(21):4435.</ref>
[[As of 2006]] the most successful hormonal treatments are orchiectomy and GnRH agonists. Despite their higher cost, GnRH agonists are often chosen over orchiectomy for cosmetic and emotional reasons. Eventually, total androgen blockade may prove to be better than orchiectomy or GnRH agonists used alone.
Each treatment has disadvantages which limit its use in certain circumstances. Although orchiectomy is a low-risk surgery, the psychological impact of removing the testicles can be significant. The loss of testosterone also causes [[Hot flush|hot flashes]], weight gain, loss of [[libido]], enlargement of the [[breast]]s ([[gynecomastia]]), impotence and [[osteoporosis]]. GnRH agonists eventually cause the same side effects as orchiectomy but may cause worse symptoms at the beginning of treatment. When GnRH agonists are first used, testosterone surges can lead to increased bone pain from metastatic cancer, so antiandrogens or abarelix are often added to blunt these side effects. Estrogens are not commonly used because they increase the risk for [[cardiovascular disease]] and [[thrombosis|blood clots]]. The antiandrogens do not generally cause impotence and usually cause less loss of bone and muscle mass. Ketoconazole can cause [[Hepatotoxicity|liver damage]] with prolonged use, and aminoglutethimide can cause skin [[rash]]es.
=== Palliative care ===
[[Palliative care]] for advanced stage prostate cancer focuses on extending life and relieving the symptoms of metastatic disease. [[Chemotherapy]] may be offered to slow disease progression and postpone symptoms. The most commonly used regimen combines the chemotherapeutic drug [[docetaxel]] with a [[corticosteroid]] such as [[prednisone]].<ref>{{cite journal| last=Tannock| first=IF| coauthors=de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN, Oudard S, Theodore C, James ND, Turesson I, Rosenthal MA, Eisenberger MA; TAX 327 Investigators| title=Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer| journal=N Engl J Med| year=2004| month=Oct 7| volume=351| issue=15| pages=1502–12| id=PMID 1547021}}</ref> [[Bisphosphonates]] such as [[zoledronic acid]] have been shown to delay skeletal complications such as [[fracture|fractures]] or the need for radiation therapy in patients with hormone-refractory metastatic prostate cancer.<ref>{{cite journal | author=Saad F, Gleason DM, Murray R, Tchekmedyian S, Venner P, Lacombe L, Chin JL, Vinholes JJ, Goas JA, Chen B | title=A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma | journal=J Natl Cancer Inst | year=2002 | pages=1458–68 | volume=94 | issue=19 | id=PMID 12359855}}</ref>
[[Bone pain]] due to metastatic disease is treated with [[opioid]] [[Analgesic|pain relievers]] such as [[morphine]] and [[oxycodone]]. External beam radiation therapy directed at bone metastases may provide [[pain]] relief. Injections of certain [[radioisotope]]s, such as [[strontium-89]], [[phosphorus-32]], or [[samarium-153-ethylene diamine tetramethylene phosphonate|samarium-153]], also target bone metastases and may help relieve pain.
==Prognosis==
Prostate cancer rates are higher and prognosis poorer in Western societies than the rest of the world. Many of the risk factors for prostate cancer are more prevalent in the Western world, including longer life expectancy and diets high in red meat and dairy products<ref>http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_prostate_cancer_36.asp</ref>. Also, where there is more access to screening programs, there is a higher detection rate. Prostate cancer is the ninth most common cancer in the world, but is the number one non-skin cancer in United States men. Prostate cancer affected eighteen percent of American men and caused death in three percent in 2005.<ref>{{cite journal| last=Jemal| first=A| coauthors=Murray T; Ward E; Samuels A; Tiwari RC; Ghafoor A; Feuer EJ; Thun MJ| title=Cancer statistics, 2005| journal=CA Cancer J Clin| year=2005| month=Jan-Feb| volume=55| issue=1| pages=10–30| id=PMID 15661684}} Erratum in: CA Cancer J Clin. 2005 Jul-Aug;55(4):259.</ref> In [[Japan]], death from prostate cancer was one-fifth to one-half the rates in the United States and [[Europe]] in the 1990s.<ref>{{cite journal| last=Wakai| first=K| title=Descriptive epidemiology of prostate cancer in Japan and Western countries| journal=Nippon Rinsho| year=2005| month=Feb| volume=63| issue=2| pages=207-12| id=PMID 15714967}} Review. {{Ja icon}}</ref> In [[India]] in the 1990s, half of the people with prostate cancer confined to the prostate died within ten years.<ref>{{cite journal| last=Yeole| first=BB| coauthors=Sunny L| title=Population based survival from prostate cancer in Mumbai (Bombay), India| journal=Indian J Cancer| year=2001| month=Jun-Dec| volume=38| issue=2–4| pages=126-32| id=PMID 1259345}}</ref> African-American men have 50–60 times more prostate cancer and prostate cancer deaths than men in [[Shanghai]], [[China]].<ref>{{cite journal| last=Hsing| first= AW| coauthors=Tsao L, Devesa SS| title=International trends and patterns of prostate cancer incidence and mortality| journal=Int J Cancer| year=2000| month=Jan 1| volume=85| issue=1| pages=60-7| id=PMID 10585584}}</ref> In [[Nigeria]], two percent of men develop prostate cancer and 64% of them are dead after two years.<ref>{{cite journal| last=Osegbe| first=DN| title=Prostate cancer in Nigerians: facts and nonfacts| journal=J Urol| year=1997| month=Apr| volume=157| issue=4| pages=1340–3| id=PMID 9120935}}</ref>
In patients who undergo treatment, the most important clinical prognostic indicators of disease outcome are stage, pre-therapy PSA level and Gleason score. In general, the higher the grade and the stage, the poorer the prognosis. [[Nomogram]]s can be used to calculate the estimated risk of the individual patient. The predictions are based on the experience of large groups of patients suffering from cancers at various stages.<ref>{{cite journal | author=Di Blasio CJ, Rhee AC, Cho D, Scardino PT, Kattan MW | title=Predicting clinical end points: treatment nomograms in prostate cancer | journal=Semin Oncol | year=2003 | pages=567-86 | volume=30 | issue=5 | id=PMID 14571407}}</ref>
==Progression==
In 1941, [[Charles Huggins]] reported that [[androgen]] ablation therapy causes regression of primary and metastatic androgen-dependent prostate cancer.<ref>Huggins C, Steven RE and Hodges CV, Studies on prostatic cancer. Arch. Sug. 43:209–223, 1941.</ref> However, it is now known that 80–90% of prostate cancer patients develop [[androgen]]-independent tumors 12–33 months after [[androgen]] ablation therapy, leading to a median overall survival of 23–37 months from the time of initiation of [[androgen]] ablation therapy.<ref>Hellerstedt BA and Pienta KJ, The current state of hormonal therapy for prostate cancer, CA Cancer J. Clin. 52: 154–179, 2002.PMID 12018929</ref> The actual mechanism contributes to the progression of prostate cancer is not clear and may vary between individual patient. A few possible mechanisms have be proposed.<ref>Feldman BJ, Feldman D. The development of androgen-independent prostate cancer. Nat Rev Cancer. 2001 Oct;1(1):34–45. PMID 11900250</ref> Scientists have established a few prostate cancer cell lines to investigate the mechanism involved in the progression of prostate cancer. LNCaP, PC-3, and DU-145 are commonly used prostate cancer cell lines. The LNCaP cancer cell line was established from a human lymph node metastatic lesion of prostatic adenocarcinoma. PC-3 and DU-145 cells were established from human prostatic adenocarcinoma metastatic to bone and to brain, respectively. LNCaP cells express [[androgen receptor]] ([[AR]]), however, PC-3 and DU-145 cells express very little or no [[AR]]. [[AR]], an androgen-activated transcription factor, belongs to the steroid nuclear receptor family. Development of the prostate is dependent on androgen signaling mediated through [[AR]], and [[AR]] is also important during the development of prostate cancer. The proliferation of LNCaP cells is [[androgen]]-dependent but the proliferation of PC-3 and DU-145 cells is [[androgen]]-insensitive.Elevation of [[AR]] expression is often observed in advanced prostate [[tumor]]s in patients.<ref>Linja MJ, Savinainen KJ, Saramaki OR, Tammela TL, Vessella RL, Visakorpi T. Amplification and overexpression of androgen receptor gene in hormone-refractory prostate cancer. Cancer Res. 2001 May 1;61(9):3550–5. PMID 11325816</ref><ref>Ford OH 3rd, Gregory CW, Kim D, Smitherman AB, Mohler JL. Androgen receptor gene amplification and protein expression in recurrent prostate cancer. J Urol. 2003 Nov;170(5):1817–21.PMID 14532783</ref> Some androgen-independent LNCaP sublines have been developed from the ATCC androgen-dependent LNCaP cells after androgen deprivation for study of prostate cancer progression. These [[androgen]]-independent LNCaP cells have elevated [[AR]] expression and express [[prostate specific antigen]] upon [[androgen]] treatment. [[Androgen]]s paradoxically inhibit the proliferation of these [[androgen]]-independent prostate [[cancer]] cells.<ref>Kokontis J, Takakura K, Hay N, Liao S. Increased androgen receptor activity and altered c-myc expression in prostate cancer cells after long-term androgen deprivation. Cancer Res. 1994 Mar 15;54(6):1566–73. PMID 7511045</ref><ref>Umekita Y, Hiipakka RA, Kokontis JM, Liao S. Human prostate tumor growth in athymic mice: inhibition by androgens and stimulation by finasteride. Proc Natl Acad Sci U S A. 1996 Oct 15;93(21):11802-7. PMID 8876218</ref><ref>Kokontis JM, Hsu S, Chuu CP, Dang M, Fukuchi J, Hiipakka RA, Liao S. Role of androgen receptor in the progression of human prostate tumor cells to androgen independence and insensitivity. Prostate. 2005 Dec 1;65(4):287-98. PMID 16015608</ref> [[Androgen]] at a concentration of 10-fold higher than the physiological concentration has also been shown to cause growth suppression and reversion of androgen-independent prostate cancer xenografts or androgen-independent prostate tumors derived [[in vivo]] model to an [[androgen]]-stimulated phenotype in athymic mice.<ref>Chuu CP, Hiipakka RA, Fukuchi J, Kokontis JM, Liao S. Androgen causes growth suppression and reversion of androgen-independent prostate cancer xenografts to an androgen-stimulated phenotype in athymic mice. Cancer Res. 2005 Mar 15;65(6):2082–4. PMID 15781616 </ref><ref>Chuu CP, Hiipakka RA, Kokontis JM, Fukuchi J, Chen RY, Liao S. Inhibition of tumor growth and progression of LNCaP prostate cancer cells in athymic mice by androgen and liver X receptor agonist. Cancer Res. 2006 Jul 1;66(13):6482–6. PMID 16818617</ref> These observation suggest the possibility to use androgen to treat the development of relapsed androgen-independent prostate tumors in patients. Oral infusion of [[green tea]] [[polyphenols]], a potential alternative therapy for prostate cancer by natural compounds, has been shown to inhibit the development, progression, and [[metastasis]] as well in autochthonous transgenic adenocarcinoma of the mouse prostate (TRAMP) model, which spontaneously develops prostate cancer.<ref>Gupta S, Hastak K, Ahmad N, Lewin JS, Mukhtar H. Inhibition of prostate carcinogenesis in TRAMP mice by oral infusion of green tea polyphenols. Proc Natl Acad Sci U S A. 2001 Aug 28;98(18):10350-5. PMID 11504910</ref>
==History==
[[Image:Hugginsprostate.jpg|thumb|right|200px|'''[[Charles B. Huggins]]''' (right), who was awarded the 1966 [[Nobel Prize]] for his research on prostate cancer, is shown with 1937 Nobel laureate [[Albert Szent-Gyorgyi]].]]
Although the prostate was first described by [[Venice|Venetian]] anatomist [[Niccolò Massa]] in 1536, and illustrated by [[Flanders|Flemish]] anatomist [[Vesalius|Andreas Vesalius]] in 1538, prostate cancer was not identified until 1853.<ref>Adams, J. ''The case of scirrhous of the prostate gland with corresponding affliction of the lymphatic glands in the lumbar region and in the pelvis.'' Lancet 1, 393 (1853).</ref> Prostate cancer was initially considered a rare disease, probably because of shorter [[life expectancy|life expectancies]] and poorer detection methods in the 19th century. The first treatments of prostate cancer were surgeries to relieve urinary obstruction.<ref>Lytton, B. ''Prostate cancer: a brief history and the discovery of hormonal ablation treatment.'' J. Urol. 165, 1859–1862</ref> Removal of the entire gland (radical perineal [[prostatectomy]]) was first performed in 1904 by [[Hugh H. Young]] at [[Johns Hopkins Hospital]].<ref>Young, H. H. ''Four cases of radical prostatectomy.'' Johns Hopkins Bull. 16, 315 (1905).</ref> Surgical removal of the testes ([[orchiectomy]]) to treat prostate cancer was first performed in the 1890s, but with limited success. [[Transurethral resection of the prostate]] (TURP) replaced radical prostatectomy for symptomatic relief of obstruction in the middle of the 20th century because it could better preserve penile erectile function. Radical retropubic prostatectomy was developed in 1983 by Patrick Walsh.<ref>Walsh, P. C., Lepor, H. & Eggleston, J. C. ''Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations.'' Prostate 4, 473-485 (1983). PMID 6889192</ref>[[Image:Schally portrait.jpg|left|thumb|150px|'''[[Andrzej W. Schally]]''' was awarded the 1977 Nobel prize for his research relating to prostate cancer.]] This surgical approach allowed for removal of the prostate and lymph nodes with maintenance of penile function.
In 1941 [[Charles B. Huggins]] published studies in which he used [[estrogen]] to oppose testosterone production in men with metastatic prostate cancer. This discovery of "chemical [[castration]]" won Huggins the 1966 [[Nobel Prize in Physiology or Medicine]].<ref>Huggins, C. B. & Hodges, C. V. ''Studies on prostate cancer: 1. The effects of castration, of estrogen and androgen injection on serum phosphatases in metastatic carcinoma of the prostate.'' Cancer Res. 1, 203 (1941).</ref> The role of the hormone [[GnRH]] in reproduction was determined by [[Andrzej W. Schally]] and [[Roger Guillemin]], who both won the 1977 Nobel Prize in Physiology or Medicine for this work.
Receptor agonists, such as [[leuprolide]] and [[goserelin]], were subsequently developed and used to treat prostate cancer.<ref>Schally, A. V., Kastin, A. J. & Arimura, A. ''Hypothalamic FSH and LH-regulating hormone. Structure, physiology and clinical studies.'' Fertil. Steril. 22, 703–721 (1971).</ref><ref>Tolis G, Ackman D, Stellos A, Mehta A, Labrie F, Fazekas AT, Comaru-Schally AM, Schally AV. ''Tumor growth inhibition in patients with prostatic carcinoma treated with luteinizing hormone-releasing hormone agonists.'' Proc Natl Acad Sci U S A. 1982 Mar;79(5):1658–62 PMID 6461861</ref>
[[Radiation therapy]] for prostate cancer was first developed in the early 20th century and initially consisted of intraprostatic [[radium]] implants. External beam radiation became more popular as stronger radiation sources became available in the middle of the 20th century. Brachytherapy with implanted seeds was first described in 1983.<ref>Denmeade SR, Isaacs JT. ''A History of Prostate Cancer Treatment.'' Nature Reviews Cancer 2, 389–396 (2002). PMID 12044015</ref> Systemic chemotherapy for prostate cancer was first studied in the 1970s. The initial regimen of [[cyclophosphamide]] and [[5-fluorouracil]] was quickly joined by multiple regimens using a host of other systemic chemotherapy drugs.<ref>Scott, W. W. et al. ''Chemotherapy of advanced prostatic carcinoma with cyclophosphamide or 5-fluorouracil: results of first national randomized study.'' J. Urol. 114, 909–911 (1975). PMID 1104900</ref>
==Miscellaneous Facts==
* Men were less likely to be hospitalized for prostate cancer treatment in 2004 than in 1997, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. Hospitalizations for treatment of the disease fell nearly 30 percent in those eight years. Prostate cancer is the second-most common cancer in men. For more information - [http://prostatenews.info/article/Prostate-Cancer-Treatment/1/Yahoo/ ProstateNews.info]
==References==
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==External links==
*{{dmoz|Health/Conditions_and_Diseases/Cancer/Genitourinary/Prostate/}}
*[http://www.prostatecancer.ca/english/home/ Prostate Cancer Research Foundation of Canada]
*[http://www.malecare.org Malecare Prostate Cancer Support]
*[http://www.prostatecancerfoundation.org Prostate Cancer Foundation]
*[http://www.nih.gov/nia/health National Institute on Aging Information Center]
*[http://www.fightprostatecancer.org/site/PageServer?pagename=homepage National Prostate Cancer Coalition (NPCC)]
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