# Prostate Cancer --- **Prostate cancer** is a [[cancer]] of the [[prostate]], and the second most common cancer in American men (lung cancer is the first). It is deadly, but relatively slow growing and fortunately it is treatable and has a relatively high survival rate. ## Risk Factors/Cause Like all cancers, there is a combination of environmental and genetic risk factors. - genetics - [[social determinants of health]] (lack of health screening) - Black men twice as likely to die of prostate cancer than any other racial/ethnic group - age - diet rich in meat and/or dairy products - saturated fats ## Signs & Symptoms Prostate cancer is usually asymptomatic until it reaches advanced stages. Then there may be signs and symptoms such as: - urinary obstruction - painful ejaculations - hematuria - sexual dysfunction Additionally, metastases may cause symptoms. Sometimes it is these symptoms that are noted first. - mets in bones - backache/hip pain - perineal/rectal discomfort - anemia - weight loss ## Diagnostic Tests A prostate biopsy is diagnostic, but there are other screenings that can be done before that. - digital rectal exam (DRE) - **prostate specific antigen** or **PSA** lab draw - this is highly sensitive, but not specific for prostate cancer; could also indicate BPH, urinary retention or even acute prostatitis - typically only recommended for men with a 10 year life expectancy or at high risk ## Treatment Treatment for prostate cancer depends on the stage of the cancer. As it is slow growing sometimes there may be a "wait and see" approach to treatment. - surgical - radical [[prostate#Prostatectomy|prostatectomy]] - first line when tumor is confined to the prostate - [[transurethral resection of the prostate]] - radiation: [[radiation therapy|brachytherapy radiation]] - strain urine to catch seeds - use condom for two weeks - avoid close contact with pregnant people and infants for up to two months. - side effects - acute urinary dysfunction - pain with urination/ejaculation - rectal urgency - diarrhea ### Androgen Deprivation Therapy **Androgen deprivation therapy** or **ADT**, which is also known as "chemical castration" suppresses the production of androgens. It works by depriving the cancer cells of the androgens they need to grow. - [[gonadotropin-releasing hormone]] agonist: **Leuprolide** (brand name: **Lupron**) - side effects - hot flashes - erectile dysfunction - decreased libido - decreased bone mass/muscle mass - sometimes given with something to prevent osteoporosis - androgen receptor blocker: **Flutamide** (brand name: **Eulixin**) - used after the tumor stops responding to the GnRH agonist - side effects - same as GnRH agonists ___