Early prostate cancer usually has no clear symptoms. Sometimes,
however, prostate cancer does cause symptoms, often similar to those of
diseases such as
benign prostatic hyperplasia. These include frequent urination,
nocturia (increased urination at night), difficulty starting and maintaining a steady stream of urine,
hematuria (blood in the urine), and
dysuria
(painful urination). A study based on the 1998 Patient Care Evaluation
in the US found that about a third of patients diagnosed with prostate
cancer had one or more such symptoms, while two thirds had no symptoms.
[13]
Prostate cancer is associated with urinary dysfunction as the prostate gland surrounds the
prostatic urethra. Changes within the gland, therefore, directly affect urinary function. Because the
vas deferens
deposits seminal fluid into the prostatic urethra, and secretions from
the prostate gland itself are included in semen content, prostate cancer
may also cause problems with sexual function and performance, such as
difficulty achieving
erection or painful
ejaculation.
[13]
Advanced prostate cancer can spread to other parts of the body,
possibly causing additional symptoms. The most common symptom is
bone pain, often in the
vertebrae (bones of the spine),
pelvis, or
ribs. Spread of cancer into other bones such as the
femur is usually to the
proximal or nearby part of the bone. Prostate cancer in the
spine can also compress the
spinal cord, causing tingling, leg weakness and
urinary and
fecal incontinence.
[14]
Risk factors
A complete understanding of the causes of prostate cancer remains elusive.
[15] The primary
risk factors
are obesity, age and family history. Prostate cancer is very uncommon
in men younger than 45, but becomes more common with advancing age. The
average age at the time of diagnosis is 70.
[16]
However, many men never know they have prostate cancer. Autopsy studies
of Chinese, German, Israeli, Jamaican, Swedish, and Ugandan men who
died of other causes have found prostate cancer in 30% of men in their
50s, and in 80% of men in their 70s.
[17] Men who have
first-degree family members
with prostate cancer appear to have double the risk of getting the
disease compared to men without prostate cancer in the family.
[18]
This risk appears to be greater for men with an affected brother than
for men with an affected father. In the United States in 2005, there
were an estimated 230,000 new cases of prostate cancer and 30,000 deaths
due to prostate cancer.
[19] Men with high blood pressure are more likely to develop prostate cancer.
[20] There is a small increased risk of prostate cancer associated with lack of exercise.
[21] A 2010 study found that prostate
basal cells were the most common site of origin for prostate cancers.
[22]
Genetic
Genetic background may contribute to prostate cancer risk, as suggested by associations with race, family, and specific
gene
variants. Men who have a first-degree relative (father or brother) with
prostate cancer have twice the risk of developing prostate cancer, and
those with two first-degree relatives affected have a fivefold greater
risk compared with men with no family history.
[23]
In the United States, prostate cancer more commonly affects black men
than white or Hispanic men, and is also more deadly in black men.
[24][25] In contrast, the incidence and mortality rates for Hispanic men are one third lower than for non-Hispanic whites.
Studies of twins in
Scandinavia suggest that 40% of prostate cancer risk can be explained by
inherited factors.
[26]
No single gene is responsible for prostate cancer; many different genes have been implicated. Mutations in
BRCA1 and
BRCA2, important risk factors for
ovarian cancer and
breast cancer in women, have also been implicated in prostate cancer.
[27] Other linked genes include the
Hereditary Prostate cancer gene 1 (HPC1), the androgen receptor, and the
vitamin D receptor.
[24] TMPRSS2-
ETS gene family fusion, specifically TMPRSS2-
ERG or TMPRSS2-
ETV1/4 promotes cancer cell growth.
[28]
Two large
genome-wide association studies linking
single nucleotide polymorphisms (SNPs) to prostate cancer were published in 2008.
[29][30]
These studies identified several SNPs which substantially affect the
risk of prostate cancer. For example, individuals with TT allele pair at
SNP rs10993994 were reported to be at 1.6 times higher risk of prostate
cancer than those with the CC allele pair. This SNP explains part of
the increased prostate cancer risk of African American men as compared
to American men of European descent, since the C allele is much more
prevalent in the latter; this SNP is located in the promoter region of
the
MSMB gene, thus affects the amount of
MSMB protein synthesized and secreted by epithelial cells of the prostate.
[31]
Dietary
While some dietary factors have been associated with prostate cancer the evidence is still tentative.
[32] Evidence supports little role for dietary fruits and vegetables in prostate cancer occurrence.
[33] Red meat and processed meat also appear to have little effect in human studies.
[34] Higher meat consumption has been associated with a higher risk in some studies.
[35]
Lower
blood levels of
vitamin D may increase the risk of developing prostate cancer.
[36]
Folic acid supplements have no effect on the risk of developing prostate cancer.
[37]
Medication exposure
There are also some links between prostate cancer and medications, medical procedures, and medical conditions.
[38] Use of the
cholesterol-lowering drugs known as the
statins may also decrease prostate cancer risk.
[39]
Infection or
inflammation of the prostate (
prostatitis)
may increase the chance for prostate cancer while another study shows
infection may help prevent prostate cancer by increasing blood to the
area. In particular, infection with the
sexually transmitted infections chlamydia,
gonorrhea, or
syphilis seems to increase risk.
[40] Finally,
obesity[41] and elevated blood levels of
testosterone[42]
may increase the risk for prostate cancer. There is an association
between vasectomy and prostate cancer; however, more research is needed
to determine if this is a causative relationship.
[43]
Research released in May 2007, found that US war veterans who had been exposed to
Agent Orange had a 48% increased risk of prostate cancer recurrence following surgery.
[44]
Infectious disease
An association with
gonorrhea has been found, but a mechanism for this relationship has not been identified.
[6]
In 2006, a previously unknown retrovirus,
Xenotropic MuLV-related virus or XMRV, was associated with human prostate tumors,
[45] but subsequent reports on the virus were contradictory,
[46][47] and the original 2006 finding was instead due to a previously undetected contamination.
[48] The journals
Science and
PlosONE both retracted XMRV related articles.
[49][50]
Sexual factors
Several case-control studies have shown that having many lifetime
sexual partners or starting sexual activity early in life substantially
increases the risk of prostate cancer.
[51][52][53]
While the available evidence is weak,
[54] tentative results suggest that frequent
ejaculation may decrease the risk of prostate cancer.
[55]
A study, over eight years, showed that those that ejaculated most
frequently (over 21 times per month on average) were less likely to get
prostate cancer.
[56] The results were broadly similar to the findings of a smaller Australian study.
[57]