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48: Prostate Cancer

Goutham Narla

Key Points

  • Disease summary:

    • Prostate cancer is the second most fatal cancer for American men. It is the most common male noncutaneous cancer in developing countries, and a leading cause of death for men 60 years or older.

    • Age, African ancestry, and a positive family history are risk factors for disease development (Table 48-1).

    • Recent evidence suggests that approximately 10% of prostate cancers are hereditary.

    • Adenocarcinoma, cancer of glandular epithelial cells, is the most commonly diagnosed form.

    • Early diagnosis significantly improves treatment response and overall survival and is based on both biochemical studies using prostate-specific antigen (PSA) levels in patients and subsequent biopsies with Gleason scoring.

    • Treatment modalities for prostate cancer include hormone-based approaches, radiation, cytotoxic chemotherapy, and radical prostatectomy. Despite proper treatment many prostate cancer patients experience recurrence and will eventually develop aggressive metastatic prostate cancer, even when presenting initially with localized or indolent disease. No consistent biomarkers yet exist to distinguish between indolent and aggressive forms. Prostate cancer’s genetic heterogeneity and complexity have hindered the elucidation and exploitation of the pathways driving pathogenesis and disease progression.

Table 48-1Risk Factors Associated With Prostate Cancer
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Table 48-1 Risk Factors Associated With Prostate Cancer
Risk Factors
Age Prostate cancer occurs more frequently in older men above the age of 50. The risk of developing prostate cancer increases with increasing age.
Family history Family history is the strongest risk factor for prostate cancer. A man with one close relative (such as a father or brother) with prostate cancer has 2× the risk of developing prostate cancer than compared to man with no family history of the disease. If two close male relatives are affected, a man’s lifetime risk of developing prostate cancer is increased fivefold.
Ethnicity Prostate cancer risk is about 60% higher in African Americans than Caucasians.
Diet A high-fat diet and low consumption of vegetables may be associated with an increased risk for prostate cancer.
Hereditary Susceptibility to prostate cancer can be inherited. It is anticipated that 5%-10% of all prostate cancer cases are hereditary. In some families, a genetic predisposition to develop prostate cancer can be passed down from parent to child.
Prostate cancer screening Screening tests include PSA and digital rectal examination (DRE). Currently there is no clinical testing for genes involved with prostate cancer.a

aMen who are concerned about their hereditary risk because of family history should discuss their concerns with their physician and consider making an appointment with a trained genetic specialist.

  • Hereditary basis:

    • While age, race, and family history are known risk factors for prostate cancer, our understanding of the genetic basis of disease remains unclear. Germline mutations, often inherited in an autosomal dominant manner, may account for 9% of all prostate cancers and 45% of cases in men younger than 55 years. Linkage-based studies, positional gene cloning, and genome-wide association studies (GWAS) have been attempted and ...

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