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Prostate Cancer

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What is prostate cancer?

Prostate cancer is the most common cancer in men after skin cancer. According to the American Cancer Society, about 241,740 new cases of prostate cancer will be diagnosed in the United States in 2012 and as many as 28,170 men will die of it. The risk of developing prostate cancer varies with ethnicity, with African American men at the highest risk. Risk is also elevated in men with a family history of the disease and increases in general as men age. More than 70% of all prostate cancers are diagnosed in men over the age of 65.

Diagram of the prostateThe prostate is a small, walnut-shaped gland that encircles the upper urethra in males and produces a fluid that makes up part of semen. Cancer that develops in the prostate may stay localized (entirely contained within the prostate) for many years and cause few noticeable symptoms. Most cases of prostate cancer are slow-growing, and symptoms begin to emerge only when the tumor mass grows large enough to constrict the urethra. This can cause symptoms such as: frequent urination, especially at night; a weak or interrupted urine stream; pain or burning upon urination or ejaculation; pus or blood in urine or semen; and discomfort in the lower back, pelvis, or upper thighs. Many of these symptoms, however, can also be caused by other conditions, such as benign prostatic hyperplasia (BPH), a urinary tract infection (UTI), acute prostatitis, or a sexually transmitted disease.

BPH is a non-cancerous enlargement of the prostate that is very common in men as they age. According to the American Urological Association, it can affect as many as 90% of men by the time they are 80 years old. It does not cause prostate cancer, but both may be found together. Doctors must determine whether a man's symptoms are due to prostate cancer, BPH, or to another non-cancer-related condition. They must also determine whether the prostate cancer they have detected is clinically significant. If a prostate cancer is small, localized, and slow-growing, it may never cause significant health problems to the person. There is a saying that "many men die with prostate cancer, not from it." In these cases, the treatments may sometimes be worse than the cancer as they can cause side effects such as erectile dysfunction and incontinence.

Some prostate cancers, however, do grow and spread aggressively into the pelvic region and then throughout the body; and some slow-growing cancers are eventually large enough and troublesome enough that they require medical intervention. The challenge for the doctor is detecting prostate cancer, evaluating its growth rate and spread, and then deciding, along with the affected person, which treatment courses to follow and when.

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