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Recent researches targeting prostate cancer have associated the prostate cancer development with the presence of a newly identified virus called XMRAV. According to study conclusion the XMRV was identified as an infectious agent in humans and closely related to a virus that causes leukemia in mice.

The findings are based of screening prostate tumor samples from 85 men with prostatectomy with a DNA ViroChip containing the genetic sequences of about 5,000 human viruses. The researches confirmed the possibility that a viral infection might lead to prostate cancer developing in men.

XMRV could be transmitted trough sexual activity. Then it is possible that XMRV to cause an infection able to lead to chronic inflammation of the prostate. In a way similar human papillomavirus (HPV) can trigger cervical cancer, this chronic inflammation caused by XMRV could result in prostate cancer.

This could be the first time an evidence is produced that a virus is related to prostate cancer development.

The research team conclusion suggests that more research is needed to confirm their findings. The good news seems to be the fact that if prostate cancer is caused by a virus such as XMRV, then its action can be cancelled using special targeted drugs or vaccine. The use of condom could be also a way to prevent XMRV sexual transmission.

According to general medical opinion regarding causes of prostate cancer, the risk factors are age, ethnic history and family background.

But recently, a research study have found that high cholesterol levels speed up the growth of prostate tumours. This conclusion may help to find an explanation regarding the fact prostate cancer is more frequent in the West world than in Asian countries because of diets high in cholesterol. For instance, in rural parts of Japan and China, where people use low fat diets, rates of prostate cancer are up to 90% less than in the West countries. It is also a reality that in United States prostate cancer hits about one in every six men.

The study author noted that the human body uses cholesterol in the synthesis of hormones known as androgens, which have a high influence on prostate tissue. Too much of cholesterol may cause an unbalanced production of this hormone. The surplus of cholesterol accumulates in the outer membranes of tumour cells leading to the development of prostate cancer.

Probably, the conclusion that drugs lowering cholesterol may help prevent prostate cancer or at least decrease its development is premature. But is a fact that watching your diet, you can be healthier.

Being diagnosed with prostate cancer for the first time will more than likely be traumatic for you and your loved ones, being diagnosed with recurrent prostate cancer can be devastating. Your doctor will prescribe a prostate cancer treatment plan that is designed to help you beat this disease. For those who have recurrent prostate cancer, there are many prostate cancer treatment that your physician may advise you to try.

Radiation Therapy

One prostate cancer treatment option is radiation therapy. This prostate cancer treatment includes the use of radiation of high energy from protons, neutrons, gamma rays and x-rays, as well as other sources to kill the cancerous cells and to shrink any existing tumors. There are two ways that radiation therapy can be administered as prostate cancer treatment. The first is from a machine that is located outside your body called external beam radiation therapy, or you may have material that is radioactive that is placed in your body near where the cancer is located. This is referred to as internal radiation therapy.

Hormone Therapy

Another prostate cancer treatment your doctor may employ is hormone therapy. This prostate cancer treatment will remove, block or add hormones. When you are suffering with recurrent prostate cancer, hormone therapy may aid in preventing the growth of the cancer. It is also used as a cancer treatment for breast cancer as well.

Prostatectomy

If you are not responding to conventional methods of prostate cancer treatment, your doctor may suggest that you have a prostatectomy. This is an operation that will remove some or all of the prostate. When you have a radical or total prostatectomy, the surgical team will remove the entire prostate gland as well as surrounding tissue.

Chemotherapy

Chemotherapy is a common prostate cancer treatment as well as a treatment for a host of other types of cancer. Chemotherapy can come with a lot of side effects and if this is the course of prostate cancer treatment your doctor recommends, you will learn about the possible side effects you may suffer with this treatment option. There may be other prostate cancer treatment other then those mentioned that your doctor will discuss at length with you.

Prostate cancer is the most common type of cancer in American men. It is the second leading cause of cancer deaths in men. Over 30,000 men in the United States will die of prostate cancer this year. Although in the early stages there are no prostate cancer symptoms, most of the prostate cancer deaths can be avoided if men paid heed to the early warning signs.

What It Means

Prostate cancer is an abnormal growth of cells that leads to the formation of a tumor in the prostrate. Prostate cancer might spread to other parts of the body, like lymph nodes, bones, and other organs. Prostate cancer is common amongst older men.

Symptoms of the Disease

Prostate cancer symptoms often appear in the late stages of the disease. But this does not mean that prostate cancer cannot be diagnosed in the early stages. Most middle aged and older men suffer from the most common prostate problem called the enlarged prostate or the benign prostatic hyperplasia (BPH). Men with enlarged prostate will show the following symptoms-

• Difficulty in starting urination

• Weak or slow flow of urination

• Need to urinate frequently

It is advisable to go see a doctor, because the doctor will run a complete check to rule out the possibility of the presence of prostrate cancer. If the problem is diagnosed as a simple enlarged prostate , the doctor will prescribe a medication, which will relieve the symptoms. If prostate cancer is diagnosed, it would probably be in its early stage, when it can be cured.

The problem arises when men ignore these symptoms as being a simple case of enlarged prostrate. Later on when they suffer from additional symptoms like:

• Pain in back, hips, and thighs

• Unexplained weight loss

• Feeling of tiredness

At this point of time when they do go to see a doctor, it might be the case that the prostate cancer is at an advanced stage. The treatment of advanced stages of prostate cancer is very hard. That is why doctors advice that when the first signs of prostate problem arise, seek the help of a health specialist.

The uncontrolled growth of cells around the outer region of the prostate, which gives rise to the development of a malignant tumor, is called prostate cancer. Prostate cancer is common among American males. Over 250,000 cases are diagnosed in the United States every year.

Early signs of prostate cancer are difficult to detect. Symptoms only set in once the tumor spreads. Change in urination habits with increased frequency or dribbling are the first signs of prostate cancer. The cancer may spread from the prostate to nearby lymph nodes, bones or other organs, leading to a condition called metastasis. As a result, some men experience back pain. Once the cancer spreads beyond the prostate it is difficult to cure.

The growth of prostate cancer is relatively slow and may not be detected for many years. It also takes longer to spread beyond the prostate. However, a small percentage of patients experience more rapidly growing, aggressive forms of prostate cancer. Unfortunately, it is difficult to know for sure which prostate cancers will grow slowly and which will grow aggressively; this further complicates treatment decisions.

The presence of cancer cells around the prostate determines the extent to which the cancer has spread. It affects the areas surrounding the prostate such as the seminal vesicle, lymph nodes, rectum and bones. Even when prostate cancer spreads to other areas, such as the bone, it is still considered to be prostate cancer and not bone cancer.

A variety of causes and contributing factors lead to prostate cancer. The major risk factors are age, race and family history. The chances of prostate cancer increase after the age of 50. The incidence of prostate cancer in Asian men is the lowest. Caucasian and African American men are the largest groups afflicted with the disease.

The prognosis for prostate cancer patients has improved over the years. The survival rates for all stages of prostate cancer have increased from 67% to 97%. Public awareness and early detection are the main reasons for the increase in survival rates.

Although the prostate-specific antigen (PSA) test has been in widespread use as a cancer screening tool for well over a decade, early detection and treatment remain clouded by unresolved questions. The argument over the value of PSA testing in asymptomatic men has been highlighted on several occasions in American Family Physician.

Updated prostate cancer screening guidelines(1) from the American Cancer Society are as follows: (1) The PSA screening test and a digital rectal examination should be offered annually to men, beginning at age 50, who have a life expectancy of at least 10 years. (2) Men at high risk should undergo initial screening at 45 years. (3) Before screening tests are conducted, patients should be given the opportunity to learn about the benefits and limitations of testing for early prostate cancer detection and its subsequent treatment.

The American Academy of Family Physicians supports the need to review with patients the appropriateness of screening for prostate cancer, recommending that men be made aware of the uncertain benefits of and the potential risks associated with screening.(2) The U.S. Preventive Services Task Force(3) does not recommend the use of PSA screening until available evidence indicates that the test saves lives.

Although the recommendations have not been changed, evidence now demonstrates that mortality rates and the incidence of advanced metastatic disease have substantially decreased since the onset of PSA-based prostate cancer screening. Whether this reduction is the result of PSA screening and the subsequent treatment of early disease can be argued; however, the recently identified decline in prostate cancer mortality in white men under 85 years of age to levels below those of the pre-PSA era, combined with a reduction in the incidence of distant disease, is highly suggestive of a positive effect of PSA testing.(4,5) Population-based studies(6,7) demonstrate a decline in mortality related to prostate cancer–apparently associated with PSA testing. A more definitive prospective randomized trial is in progress,(8) but the results will not be available for several more years. Meanwhile, the use of PSA screening continues to expand. As physicians, what are we to do?

We daily offer patients many preventive health interventions; for some of these interventions, effectiveness and mortality reduction are evidence-based (e.g., mammography) and, for other interventions, they are self-evident but not “proved” through randomized, controlled trials (e.g., Papanicolaou smears). Where in our busy schedule does the PSA screening test fit? How much discussion and education are appropriate? Patients no longer accept health care being dictated to them on a “doctor knows best” basis, but they still depend on us for guidance and direction. In light of the current state of the science related to the PSA test, our responsibility is to make our patients aware that the PSA assay is available and to help them understand the associated implications.

Patients should be helped to understand that the PSA assay is not specific for cancer, that some benign conditions can result in an “abnormal” level, and that some cancers may exist despite a PSA value within the normal range. The conversation should also include the “next steps” that would be necessary if the test result is abnormal, including referral for additional tests (e.g., ultrasonography, needle biopsy).

Discussing selection of therapy and choosing among various options, including watchful waiting, can be specifically framed only in the context of a known histologic diagnosis and tumor grade. Patients should, however, have a general understanding that any benefit associated with testing and a reduced risk of mortality from prostate cancer can be obtained only by use of treatment interventions that also have risks.

We should advise our asymptomatic patients when routine consecutive testing most likely will be of little benefit because of advanced age or the presence of serious comorbid conditions. We should advise patients of the need for vigilance when they are at increased risk (because of race or a family history of cancer) of developing or dying of prostate cancer. They should be aware that the PSA test can detect prostate cancer at an earlier and potentially more treatable stage and may improve their chance for survival. This is the essence of an informed decision.

It has been suggested that, given the limited time available to discuss preventive issues, we should focus our efforts on interventions with known efficacy. A decision on our part not to present patients with the option of PSA testing is tantamount to placing patients who may have asymptomatic prostate cancer into treatment with watchful waiting without their consent. However, this is not an informed decision, and the patient may not be pleased with the outcome.

While counseling is time-consuming, it seems that the best option is to provide patients with the most current information and allow them to select the best course of action. We are much more likely to have satisfied patients in the future if we make the necessary investment of time to allow them to participate in the decision-making process today.

Neurologic complications continue to pose problems in patients with metastatic prostate cancer. From 15 to 30 percent of metastases are the result of prostate cancer cells traveling through Batson’s plexus to the lumbar spine. Metastatic disease in the lumbar area can cause spinal cord compression. Metastasis to the dura and adjacent parenchyma occurs in 1 to 2 percent of patients with metastatic prostate cancer and is more common in those with tumors that do not respond to hormone-deprivation therapy. Leptomeningeal carcinomatosis, the most frequent form of brain metastasis in prostate cancer, has a grim prognosis. Because neurologic complications of metastatic prostate cancer require prompt treatment, early recognition is important. Physicians should consider metastasis in the differential diagnosis of new-onset low back pain or headache in men more than 50 years of age. Spinal cord compression requires immediate treatment with intravenously administered corticosteroids and pain relievers, as well as prompt referral to an oncologist for further treatment. (Am Fam Physician 2002;65:1834-40. Copyright[C] 2002 American Academy of Family Physicians.)

Prostate cancer is second only to lung cancer as the leading cause of cancer-related deaths in men.(1) Histologic evidence of prostate adenocarcinoma is present in 30 percent of men more than 50 years of age and in 70 percent of men more than 80 years old. About 9.5 percent of men will have a clinical diagnosis of prostate cancer in their lifetime, and 2.9 percent will succumb to this malignancy.(2,3)

Although most men with prostate cancer have asymptomatic, indolent disease, central nervous system (CNS) complications often occur with advanced metastatic disease(4,5) (Table 1).(4-6) CNS involvement may present as back pain caused by spinal cord compression resulting from bone metastasis via the paravertebral venous plexus or, less commonly, as headache or neurologic changes caused by the hematogenous spread of prostate cancer to the brain. Paraneoplastic syndromes, including neuropathies (sensory, peroneal, etc.), cerebellar ataxia, and limbic and brain-stem encephalitides, may also occur; discussion of these rare complications is beyond the scope of this article.(7,8)

TABLE 1

More Common Neurologic Complications in Patients with Metastatic
Prostate Cancer[*]

Complication
(incidence, %)      Clinical clues (incidence, %)

Spinal cord         Localized back pain
compression         (90 to 95)
caused by         Weakness (75 to 80)
metastasis (7)    Autonomic dysfunction (57)

Sensory changes (50)

Brain metastasis    No symptoms (?)
(1 to 2)          Headaches (34)
Motor deficits (26)
Altered mental status (23)
Seizures (8)

Complication
(incidence, %)      Treatment options

Spinal cord         Dexamethasone sodium phosphate (Decadron):
compression         16 to 100 mg administered as an intravenous
caused by           bolus; then 4 mg given intravenously four times daily
metastasis (7)      for 3 days; tapered over about 14 days
Morphine, hydromorphone (Dilaudid),
fentanyl (Duragesic), or oxycodone
(Roxicodone) for pain management
Oncology referral

Brain metastasis    Dexamethasone, as above, if magnetic
(1 to 2)            resonance image shows edema
Anticonvulsants (not as prophylaxis, and
not phenytoin [Dilantin] if radiotherapy
is anticipated, because of the risk
of Stevens-Johnson syndrome with
concomitant treatment)
Oncology referral

? = unknown.

[*]–The rarer neurologic complications include paraneoplastic syndromes
such as peroneal neuropathy (peroneal nerve palsy related to local
metastasis), cerebellar ataxia, limbic encephalitis and brain-stem
encephalitis.

Information from references 4, 5, and 6.

Lesions in the brain and spinal cord require prompt treatment. Hence, family physicians need to consider metastatic prostate cancer in the differential diagnosis of new-onset back pain or headache in men more than 50 years of age.

Anatomy and Metastasis of Prostate Cancer

The pudendal nerve innervates the few striated muscles within the prostatic capsule. The parasympathetic nerves emanate from S2 to S4 and form the pelvic nerve. The sympathetic preganglionic nerves, which reside in the thoracolumbar region between T6 and L2, provide the major neural input to the prostate and reach the pelvis through the hypogastric nerve (Figure 1).

Prostate cancer has been shown to metastasize by following the venous drainage system through the lower paravertebral plexus, or Batson’s plexus.(4,9) Although hematogenous spread of other malignancies is most commonly to the lungs and liver, 90 percent of prostatic metastases involve the spine, with the lumbar spine affected three times more often than the cervical spine. Prostate cancer also spreads to the lungs in about 50 percent of patients with metastatic disease, and to the liver in about 25 percent of those with metastases.

A 62-year-old man with androgen-independent metastatic prostate cancer that had failed to respond to multiple treatment regimens stopped all conventional therapy and began 10 mg/day of lycopene and 300 mg of saw palmetto 3 times per day. The prostate-specific antigen (PSA) level decreased from 365 ng/ml to 140 ng/ml after 1 month and to 8.1 ng/ml after 2 months. A repeat bone scan revealed an improvement of bony metastases. He has continued the lycopene and saw palmetto and has remained asymptomatic for an unspecified period of time.

Comment: Androgen-independent prostate cancer is difficult to treat and has a relatively poor prognosis. This case report, which demonstrates a partial remission, is therefore quite promising. The authors of the study attributed the benefit solely to the lycopene, since saw palmetto does not typically reduce PSA levels in men with BPH. However, it is not possible to rule out an anti-cancer effect of saw palmetto in this patient. Moreover, it is difficult to believe that such a small amount of lycopene, which can be obtained from less than 3 tablespoons of spaghetti sauce per day, could by itself have such a profound impact on a patient with advanced, treatment-resistant prostate cancer. Clearly, additional trials with these natural compounds are warranted.

Twenty-five men with prostate cancer who were awaiting prostatectomy were prescribed a low-fat diet (maximum fat content, 20% of total energy) supplemented with 30 g/day of ground flaxseed, with added stabilizers to prevent rancidity. The mean duration of diet therapy was 33.7 days (range, 2177 days). Compared with baseline values, diet therapy was associated with a significant 15% decrease in serum total testosterone (p <0.05) and a 19% decrease in the free androgen index (p < 0.05). No significant change was seen in serum prostate-specific antigen (PSA) levels. The mean tumor proliferation index was 5.0, compared with 7.4 in a group of historic controls matched for age, race, PSA level, and Gleason sum (p = 0.05).

Comment: Epidemiological studies have suggested that ingestion of large amounts of alpha-linolenic acid (the main fatty acid present in flaxseed and flaxseed oil) is associated with an increased risk of developing prostate cancer. However, epidemiological studies do not indicate cause-and-effect, and no long-term intervention trials have been done. Although the present study does not demonstrate a clear benefit of flaxseed supplementation in men with prostate cancer, neither is there any hint of an adverse effect. Thus, there is no strong evidence that consuming moderate amounts of non-rancid flaxseed or flaxseed oil would increase the risk of developing prostate cancer. However, alpha-linolenic acid is an unstable molecule that readily undergoes spontaneous oxidation, and it is conceivable that oxidative byproducts of this fatty acid could be carcinogenic. Therefore, foods that are rich in alpha-linolenic acid should be kept airtight and refrigerated, and should not be cooked at high temperatures.

Prostate cancer is the second leading cause of cancer death among men. Every year, approximately 40,000 American men die of this disease and one out of eight men will develop prostate cancer during his lifetime.

Since prostate cancer does not usually display symptoms in its early stages, researchers are searching for genetic markers to aid in diagnosis and treatment. A new study from the University of Michigan Medical School, published in the August 23, 2001 issue of Nature, gave scientists their first look at the genetic and molecular profile of prostate cancer.

“The potential significance of this research is in three areas–diagnosis, prognosis and therapeutic,” says Mark Rubin, M.D., co-author of the study. “The ultimate goal is to develop tests that could help us identify the presence of prostate cancer and determine which patients have this aggressive disease. More importantly, we hope to identify genes we can target for therapy.”

* The prostate is a gland in the male reproductive system. It contributes to seminal fluid–a milky fluid that nourishes sperm and is released to form part of semen. The prostate surrounds the upper part of the urethra, the tube that transports urine from the bladder. If the prostate grows too large, the flaw of urine con be slowed or interrupted.

* The risk of developing prostate cancer increases with age, with about 60 percent of cases diagnosed in men over age 60. Other risk factors include a family history of prostate cancer or being of African-American descent.

* Men over age 50 should have an annual prostate check-up, consisting of a digital rectal exam and a blood test to measure a protein called prostate-specific antigen (PSA). Men with additional risk factors should begin annual check-ups at age 40.

* Both advanced prostate cancer and benign prostate enlargement can produce the following symptoms: weak or interrupted urine flow, frequent or difficulty urinating, blood in the urine, painful urination or ejaculation, prolonged pain in the lower back, pelvis or upper thighs.