What causes prostate cancer What causes prostate cancer to grow

The exact causes of prostate cancer are not known. Prostate cancer may develop because of changes in genes. Alterations in androgen (male hormone) related genes have been associated with an increased risk of cancer. Alterations in genes may be caused by environmental factors, such as diet. The more abnormal the gene, the higher is the likelihood of developing prostate cancer. In rare cases, prostate cancer may be inherited. In such cases, 88% of the individuals will have prostate cancer by the age of 85 years. Males who have a particular gene, the breast cancer mutation (BRCA1), have a threefold higher risk of developing prostate cancer than do other men. Changes in a certain chromosome, p53, in prostate cancer are associated with high-grade aggressive prostate cancer.

Table 4 Common Symptom-Directed Treatment Strategies in Advanced Prostate Cancer

Symptom

Treatment

Localized metastasis: external beam Widespread metastasis: total body irradiation; intravenous infusion Bisphosphonates

Zoledronic acid alendronate, neridronate Intravenous/intravenous + oral Steroids

Oral prednisone Chemotherapy Mitoxantrone

Investigational regime: taxotere/estramustine Analgesics NSAIDs Narcotic agents

Bone fracture

Surgical stabilization

Bladder obstruction

Hormonal treatment Transurethral prostatectomy Repeated debulking transurethral resections Alum irrigation

Urethral catheter balloon intervention (< 24 hr) Surgery

Ureteral obstruction

Endocrine therapy Radiation therapy Percutaneous nephrostomy Indwelling ureteral stents

Spinal cord compression

Intravenous and/or oral steroids Posterior laminectomy Radiation therapy

Dissemination intravascular coagulation (DIC)

Intravenous heparin and EACA

Supplementation (e.g., platelets, fresh whole blood, packed erythrocytes, frozen plasma, or cryoprecipitate)

Anemia

Iron and vitamin supplementation

Bone marrow stimulants (e.g., erythropoietin)

Transfusion therapy

Edema

Compression stockings Leg elevation Diuretics

EACA, epsilon aminocaproic acid; NSAIDs, nonsteroidal anti-inflammatory drugs.

From Smith JA et al. Urology 1999; 54(suppl 6A):8—14. Reprinted with permission from Elsevier

Science.

EACA, epsilon aminocaproic acid; NSAIDs, nonsteroidal anti-inflammatory drugs.

From Smith JA et al. Urology 1999; 54(suppl 6A):8—14. Reprinted with permission from Elsevier

Science.

Prostate cancer, similar to breast cancer, is hormone sensitive. Prostate cancer growth is stimulated by the male hormones testosterone and dihydrotestosterone (a chemical that the body makes from testosterone). Testosterone is responsible for many normal changes, both physical and behavioral, that occur in a man's life, such as voice change and hair growth. The testis makes almost 90% of the testosterone in the body. A small amount of testosterone is made by the adrenal glands (a paired set of glands found above the kidneys that produce a variety of substances and hormones that are essential for daily living). In the bones, a chemical called transferrin, which is made by the liver and stored in the bones, also appears to stimulate the growth of prostate cancer cells. When cancers develop, they secrete chemicals that cause blood vessels to grow into the cancer and bring nutrients to the cancer so that it can grow.

Prostate cancer, similar to breast cancer, is hormone sensitive.

Adrenal glands

Glands located above each kidney. These glands produce several different hormones, including sex hormones.

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