Contributing Factors
Risk of developing prostate cancer increases with age. More than 75 percent of men diagnosed with prostate cancer each year are over age 65. African Americans have a higher risk of prostate cancer than other ethnic groups. Dramatic differences in the incidence of prostate cancer are seen in different countries, and there is some evidence that diets high in animal fats may contribute to increased risk. Genetic factors also appear to play a role, particularly for families where prostate cancer is diagnosed in men under age 60. The relative risk of prostate cancer rises with the number of close relatives who have the disease. Other potential risk factors besides age, race, and family history of the disease include alcohol consumption, vitamin or mineral interactions, and other dietary habits.

Detection/diagnosis
Prostate cancer often does not cause symptoms in its earliest stages. When symptoms do occur, they may include: frequent urination (especially at night), inability to urinate, trouble starting or holding back urination, a weak interrupted flow of urine, painful urination, blood in urine or semen, painful ejaculation, and frequent pain or stiffness in the lower back, hips or upper thighs. Because symptoms are often not apparent until the disease has spread beyond the prostate, two tests are commonly used to detect prostate cancer in the absence of symptoms. One is the digital rectal exam, in which a doctor inserts a gloved, lubricated finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas. The other is a blood test used to measure levels of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP). High levels of PSA and PAP are common in men with prostate cancer. The doctor cannot diagnose prostate cancer with these tests alone because elevated PSA and PSP levels may also indicate other, noncancerous problems. However the doctor will take the results of these tests into account when deciding whether to check for further signs of cancer. Other tests the doctor may order include transrectal ultrasonography, intravenous pyelogram, and cytoscopy. If test results indicate cancer may be present, the patient will need to have a biopsy, the only sure way to determine whether a problem is cancer. During a biopsy, the doctor removes a small amount of prostate tissue, usually with a needle. The tissue is then examined by a pathologist who looks for cancer cells. If cancer is present, the pathologist usually reports the grade of the tumor. The grade tells how closely the tumor resembles normal prostatic tissue and suggests how fast the tumor is likely to grow.

Staging
If cancer is found in the prostate, the doctor needs to know the stage, or extent, of the disease so the proper course of treatment can be determined. During staging, the doctor may use various blood and imaging tests to find out whether the cancer has spread and, if so, what parts of the body are affected. The progression of the disease is usually classified as follows:

Stage I (A): The cancer cannot be detected by rectal exam and causes no symptoms. The cancer is usually discovered during surgery to relieve problems with urination. Stage I tumors may be in more than one area of the prostate, but there is no evidence of spread outside the gland.

Stage II (B): The tumor is felt in a rectal exam or detected by a blood test, but there is no evidence that the cancer has spread outside the prostate.

Stage III (C): The cancer has spread outside the prostate to nearby tissues.

Stage IV (D): Cancer cells have spread to lymph nodes or to other parts of the body.

Conventional treatment
Many men whose prostate cancer is slow growing and found at an early stage may not need treatment. Also, treatment may not be advised for older men or men with other serious medical conditions. For these men, the risks of treatment may outweigh the possible benefits and the doctor may suggest "watchful waiting," i.e., following the patients progress and treating symptoms as they arise. Treatment for prostate cancer may involve surgery, radiation therapy, hormone therapy, or a combination of these treatments. Researchers continue to investigate other methods of treatment to find out whether they are effective against this disease.

Surgery
Surgery is a common treatment for the early stages of prostate cancer. Surgery to remove the entire prostate gland is called radical prostatectomy. This is done either by retropubic prostatectomy, where the prostate and neighboring lymph nodes are removed through an incision in the abdomen, or perineal prostatectomy, where the prostate is removed through an incision between the scrotum and the anus. A separate incision in the abdomen is sometimes used to remove the nearby lymph nodes. Radical prostatectomy often causes permanent impotence and sometimes causes urinary incontinence. New "nerve-sparing" surgical techniques may help make these side effects less common.

Radiation therapy
Another way to treat prostate cancer is radiation therapy (also called radiotherapy). In this form of treatment, high energy rays are used to damage cancer cells and stop them from reproducing. In early stage cancer, radiation can be used instead of surgery, or it can be used after surgery to destroy any cancer cells that may remain in the area. Radiation may be directed at the body by a machine (external radiation), or it may come from radioactive material placed directly into or near the tumor (internal radiation). Some patients receive both kinds of therapy. Common side effects of radiation therapy include fatigue, frequent and uncomfortable urination, hair loss in the pelvic region, and impotence. Impotence is less common with internal radiation than with external radiation because internal radiation is not as likely to damage the nerves that control erection.

Hormone therapy
Hormone therapy prevents the prostate cancer cells from getting the male hormones they need to grow. Lowering male hormone levels can affect all prostate cancer cells, even if they have spread to other parts of the body. For this reason, hormone therapy is often the treatment of choice for later-stage prostate cancer. There are several forms of hormone therapy. In some cases, the testicles are surgically removed (orchiectomy), eliminating the main source of male hormones. In another form of hormone therapy, patients take the female hormone estrogen to stop the testicles from producing testosterone. The use of a substance called luteinizing hormone-releasing hormone agonist (LHRH) is another form of hormone therapy that prevents testosterone production. Although prostate cancer that has spread to other parts of the body can be controlled with hormone therapy for a period of time (often several years), eventually most prostate cancers are able to grow with little or no male hormones. When this happens, homone therapy is no longer effective. Common side effects of hormone therapy include loss of sexual desire, impotence, and hot flashes. Patients receiving estrogen may have nausea, vomiting, or tenderness and swelling of the breasts. Estrogen therapy also increases a man's risk of heart problems and therefore is not appropriate for men with a history of heart disease.²

Nutritional Considerations
The role of nutrition in the development of prostate cancer is still being studied, with most of the research focusing on antioxidants like vitamin E, lycopene, selenium, and zinc. Abnormally low zinc levels are common in patients with prostate cancer, and may play a role in the progression of the disease.^3,4 Large-scale studies have shown that men who supplemented 200 mcg of selenium per day had significantly lower incidence of prostate cancer than men who did not.^5,6 One large study conducted on 50 to 69 year old male smokers in Finland found that men who took vitamin E supplements daily for five to eight years had 32 percent fewer diagnoses of prostate cancer and 42 percent fewer prostate cancer deaths compared to men who did not receive the supplement.⁷ Other studies indicate that diets rich in lycopene, an antioxidant found in tomatoes, may also significantly reduce prostate cancer risk.^8-10 While more research is needed to determine the full potential of these nutrients in cancer prevention, it seems advisable for men at risk for prostate cancer to consume a diet rich in antioxidants, as they provide many benefits for overall health.