John Swanson, MD
staging is extremely important in assessing mortality and morbidity risk for any cancer. The diagram, table and this discussion are meant to help illustrate and explain some of the difficulties associated with prostate cancer staging. First, clinical staging in the absence of pathology reports of the prostate gland is frequently inaccurate. One study found that 66% of clinical stages were upgraded (worsened) after pathologic examination. Information given in Table 1 shows the need for pathological staging. Clinical staging often involves guesswork. This has particular importance for us in underwriting as external radiation therapy, brachytherapy and watchful waiting gain in popularity.
Next, there is the problem of 2 different staging classifications. The American Urological Association established he modified Whitmore-Jewett A through D staging system. For consistency with other cancers, the American Joint Committee on Cancer (AJCC) recommends use of the TNM system. T1 equates with stage A, T2 with stage B, and T3 and T4 with stage C. Table 1 compares the 2 classifications
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Bob Leibowitz, M.D, Isaac Gorbaty, M.D, Mary Duong, P.A.-C
The package insert that accompanies any type of prescription for testosterone replacement products states that testosterone is “contraindicated in men with prostate cancer.” This means that you should never use any form of testosterone if you have prostate cancer. 99.9% plus of all physicians believe that if you give testosterone to a patient with prostate cancer, it’s “like adding gasoline to a fire.” We are taught that testosterone will markedly stimulate the growth of prostate cancer cells, cause widespread metastatic disease, and greatly hasten death. Testosterone replacement therapy has also been reported to cause permanent paralysis.
A number of years ago, I reviewed the medical literature regarding the relationship between testosterone and prostate cancer, especially in men who were previously treated for prostate cancer. I previously discussed this subject in detail in my September 2003 paper, “High-Dose Testosterone Replacement Therapy,” and the interested reader is directed to this paper.
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Prostate cancer is the most common cancer in men in the UK (24%) and has a death rate second only to lung cancer (13%) (Cancer Research UK). Incidence of prostate cancer has risen sharply over the last 20 years whereas mortality has only increased slightly. Prostate cancer is more common in older men and has a variable biologic course; therefore a gap between incidence and mortality has always been present due in part to death from intercurrent illness. Although factors such as improved treatment or changes in prostate cancer definition and coding may be responsible for the current rising discrepancy between incidence and mortality, increased uptake of prostate specific antigen (PSA) screening may play a role at detecting cancers that may not have become clinically significant.
PSA screening means that a prostate cancer will often be discovered earlier in its clinical course. Once a prostate cancer is detected a management strategy must be defined. If the cancer is indeed detected early, there are a variety of management options available to patients. The choice of treatment depends on many factors both specific to the disease and on the patient’s choice. The references given are intended predominantly to lead the reader to more detailed review articles and overviews.
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Prostate cancer is an important concern for all men since it poses a health threat especially to men over he age of 40. However, there is a higher prevalence of this disease among Black men compared to men from other racial or ethnic groups in the United States. Actually, According to the American Cancer Society facts and figures (2002), American Blacks are seen as having the highest incidence rates of prostate cancer in the world. In general, Blacks are more likely to have prostate cancer detected at a later stage and the incidence as well as mortality rates of prostate cancer among Blacks are disproportionately higher than White males. Blacks are more prone to die from the disease when compared with Whites (Merrill, & Lyon, 2000). In addition to late detection, socioeconomic status is an important factor in the morbidity and mortality rates of prostate cancer (Boring, et. al. 1992; Bal, 1992). There is still a lack of knowledge regarding prostate cancer screening as well as symptoms and treatment modalities more so for Black men than for Whites (Nash & Hall, 2002).
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International Congress on Hormonal Steroids and Hormones and Cancer
G P Risbridger, J J Bianco, S J Ellem and S J McPherson
Monash Institute of Reproduction and Development (Centre for Urological Research), Monash University,
Melbourne, Victoria, Australia

Men and women synthesise both androgens and oestrogens, but the relative ratio of the two hormones between the two sexes is markedly different. The importance of androgens to the male is unequivocal whereas the roles of oestrogens are less clear. Oestrogen synthesis occurs via aromatisation of androgens utilising the aromatase enzyme (cytochrome P450arom); therefore the aromatase enzyme is a critical regulator of the balance between the androgens and oestrogensthat contributes to circulating and tissue levels of these hormones. In men, the balance between systemic levels of androgens and oestrogens is altered significantly upon aging; plasma androgen levels decline whereas oestradiol levels remain relatively constant (Vermeulen et al. 2002). In specific tissues of the body, the balance between androgens and oestrogens may differ significantly from that in theplasma but is nevertheless dependent upon the presence and activity of locally produced steroid metabolising enzymes, such as 5á-reductase and aromatase (Voigt & Bartsch 1986,

Negri-Cesi et al. 1998, 1999, Weber et al. 1999, Steers 2001). The role of local synthesis of steroids has assumed increasing importance in some disease states, particularly in glandular tissue such as the breast, wherein abnormal levels of oestradiol promote the development and proliferation in the early stages of malignant transformation of epithelial cells (Simpson et al. 1994, Santen et al. 1997).
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According to the National Cancer Institute of Canada (2005), prostate cancer is the most frequent cancer and the third leading cause of death from cancer in men, exceeded only by lung cancer and colorectal cancer. Prostate cancer accounts for 26% of all male cancers and 12% of male cancer-related deaths. While the incidence has increased significantly over the past 35 years, the mortality rate is declining in Canada. Between 1992 and 2001 the prostate cancer mortality rate in Canada had a 2% average annual decline.It is estimated that in 2005 there will be 36,700 deaths from cancer in men of which 4,300 will be due to prostate cancer.

Risk factor for prostate cancer is :
Age : The prevalence of prostat cancer increases with age, especially over the age of 60, both incidence and mortality rates due to prostat cancer increase strikingly
Family history: It is claimed that prostat cancer has a hereditary component. Men with a family history of PC are at increased risk of developing PC from 1.5 to 4 times more than the general population

Diet: The dietary differences between diverse geographic regions and various racial/ethnic populations provide an interesting possible explanation for differences in the incidence and mortality of prostat cancer

Smoking status and alcohol consumption: The effects of smoking and alcohol on the epidemiology of prostat cancer are inconclusive and difficult to interpret. Hsing and colleagues (2002) demonstrated a relative risk of 1.8 for smoking. In line with our findings, most of the studies, although not all, that used incident prostate cancer cases in analyses observed no association among smoking status, alcohol consumption and risk of prostate cancer development

Diabetes mellitus: It is stated that men with diabetes mellitus appear to have a lower risk of developing prostat cancer
Sex steroid hormones: Although hormones play an important role in normal and cancerous prostate physiology including growth, differentiation and progression; their relationship to the risk of prostat cancer remains undefined and needs to be interpreted with caution

Sexual behavior and vasectomy: Some studies suggest that prostat cancer is related to the frequency of sexual activity, early intercourse, number of sexual partners, sexually transmitted diseases, prostatic infection, fertility, marital status and vasectomy.
Nevertheless, there are some

Prostate Cancer Priority Strategic Plan
since 1991, prostate cancer has been the most frequently diagnosed cancer (other than skin cancers) in Michigan. In 2003, Michigan had the third highest incidence rate of prostate cancer in the nation; 8,119 Michigan men were diagnosed with prostate cancer. African American men in Michigan were diagnosed with prostate cancer at almost one and a half times the rate of Caucasian men in Michigan in 2001.
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Nutrition & Prostate Cancer
Scientific evidence suggests that differences in diet and lifestyle may account in large part for the variability of prostate cancer rates in different countries.
Good nutrition may reduce the incidence of prostate cancer and help reduce the risk of
prostate cancer progression. There are many studies currently being conducted to help
further understand how diet and prostate cancer are related. We do know, however,
that improved nutrition reduces risk of heart disease, diabetes, and obesity, and usually
improves overall quality of life. It is estimated that one-third of cancer deaths in the U.S. can be attributed to diet in adulthood, including diet’s effect on obesity. Additionally, a healthy diet helps to increase energy levels, facilitate recovery, and enhance the immune system
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A radical prostatectomy is an operation to remove the prostate gland and some of the tissue around it. It is done to remove prostate cancer. This operation may be done by open surgery or by laparoscopic surgery through small incisions.
See Prostate Cancer radical Prostatectomy Video

Prostate cancer is the second most common cause of cancer death among men in the U.S. It was diagnosed in more than 180,000 men and claimed the lives of more than 28,000 men in the U.S. last year.
The novel agent, called abiraterone, shrank tumors by 30% or more in one-fourth of 31 patients whose prostate cancer continued to spread despite standard hormone therapy. In an additional 35% of men, tumors stopped growing.
The researchers also used PSA levels to evaluate abiraterone's effectiveness. PSA levels are a measure of a protein called prostate-specific antigen, which is produced by cells in the prostate. High PSA levels can signal cancer. The National Cancer Institute views a response to treatment as being seen when there is at least a 50% decline in PSA blood level.
After 12 weeks of treatment, abiraterone reduced PSA levels by 50% or more in 71% of the men. In two men, PSA fell to undetectable levels.
"This is currently the most promising prostate cancer drug on the horizon," says ASCO spokesman Howard Sandler, MD, chairman of radiation oncology at the Samuel Oschin Cancer Institute at Cedars-Sinai Medical Center in Los Angeles.
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