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Prostate Cancer

Prostate cancer is the most common cancer in the male reproductive system, occurring most commonly in elderly men. The incidence of prostate cancer has been rising in Hong Kong. In 2010, prostate cancer was listed as the third most common cancer in men1 after colon cancer and lung cancer, and it was also the fifth most common cause of cancer death in men.1

 

The prostate is a part of the male reproductive system - a walnut-shaped gland, which is located underneath the bladder, in front of the rectum and surrounding the urinary tract. The prostate is made up of three zones – the central zone, transitional zone, and peripheral zone. The transitional zone is an area where benign prostate growth is commonly observed, and prostate cancer growth occurs most commonly in the peripheral zone (in front of the rectum).2

 

The etiology of prostate cancer is still not understood; it may be due to many different factors. For example, the risk of prostate cancer significantly increases with age. It is rare to be diagnosed with prostate cancer before the age of 40; however, the number of such cases increases rapidly after the age of 50. In fact, more than 80% of these cases are men above the age of 65. In addition, certain factors, such as family history, dietary habits, and obesity, have been linked to prostate cancer.2

 

In general, prostate cancer can be divided into three stages:2

  • Early localized cancer: the cancer cells are only localized within the prostate.
  • Locally advanced cancer: the cancer cells have spread beyond the prostate but are limited to the tissues surrounding the prostate and seminal vesicles.
  • Metastasized cancer: the cancer cells have spread to the lymph nodes, bones, or other organs such as the liver and lungs.

There are many ways to treat prostate cancer. The doctor will prescribe the most suitable treatment plan based on the patient’s age, cancer stage, and overall health condition. Treatment methods include surgery, hormonal treatment, radiation therapy, and chemotherapy, etc.

 

Patients with metastatic, advanced prostate cancer will usually be treated with androgen deprivation therapy to lower the testosterone level and thereby control the growth of tumor cells. However, the disease will usually be progressed in one to two years. Prostate cancer at this stage is called metastatic castration-resistant prostate cancer (mCRPC)3-4.

 

The main reasons that androgen deprivation therapy becomes ineffective in controlling disease progression include5

  • Increased androgen receptors and overexpression of these receptors
  • Adrenal androgen is not fully inhibited
  • Production of androgen by cancer cells

Doctors will provide an appropriate treatment plan based on the patient’s age, overall health condition, the side effects of these drugs, etc. Main treatments for mCRPC include chemotherapy, oral hormonal medications and radiopharmaceuticals.

 

Reference:

1.Hong Kong Cancer Registry, Hospital Authority. Leading cancer sites in Hong Kong in 2010. Available at: http://www3.ha.org.hk/cancereg/statistics.html (last accessed January 2013).
2.Hong Kong Urological Association website: http://hkua.org/healthinfo.php (last accessed Aug 2013)
3.Beltran H, et al. New therapies for castration-resistant prostate cancer: efficiency and safety. Eur Urol 2011;60:279–90.
4.Cancer.net. Treatment of Metastatic Castration-Resistant Prostate Cancer. http://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/treatment-metastatic-castration-resistant-prostate-cancer (last accessed July 2016)
5.Sanford M. Enzalutamide: A review of its use in metastatic, castration-resistant prostate cancer. Drugs 2013;73:1723-1732.

 

 

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