Germline mutations in RNASEL and MSR1 , encoding proteins that function in host responses to infection, appear responsible for some cases of hereditary prostate cancer.
An inflammatory lesion, termed proliferative inflammatory atrophy (PIA), is an early precursor to prostate cancer.
Somatic inactivation of GSTP1 , encoding a carcinogen-detoxification enzyme, may initiate prostatic carcinogenesis by increasing the vulnerability of prostate cells to damage mediated by oxidant and electrophilic carcinogens.
Gene fusions, involving TMPRSS2 and ETS family transcription factor genes, may contribute to the androgen dependence of prostate cancers.
Defects in the functions of NKX3.1, PTEN, and CDKN1B are common in prostate cancer cells.
Management options include observational strategies (watchful waiting and active surveillance), anatomic radical prostatectomy (with or without robot-assisted laparoscopic techniques), external beam radiation therapy, and brachytherapy.
A progressive rise in the serum PSA after treatment indicates prostate cancer recurrence.
Depending on the approach used, side effects associated with treatment of localized prostate cancer can include urinary, bowel, and sexual dysfunction.
Salvage therapy for prostate cancer recurrences after initial treatment include external radiation after surgery, or include surgery, brachytherapy, or cryosurgery after external beam radiation.
Androgen suppression, most often accomplished via the use of luteinizing hormone–releasing hormone (LHRH) analogs or antagonists, with or without antiandrogens, is the most commonly used treatment.
Side effects can include loss of libido, hot flashes, gynecomastia, loss of lean muscle mass and bone density, and the development of metabolic syndrome.
Docetaxel and cabazitaxel chemotherapy improves the survival of men with progressive androgen-independent prostate cancer.
Second-line treatments targeting the androgen-signalling pathway, including abiraterone acetate and enzalutamide, prolong survival of men previously treated with androgen suppression and taxane chemotherapy.
Bisphosphonates and denosumab antagonize loss of bone density accompanying androgen deprivation, and reduce skeletal complications associated with metastatic prostate cancer progression.
Sipuleucel-T, a dendritic cell vaccine, has shown a survival benefit in men with advanced prostate cancer. Other immunotherapies are under development in clinical trials.
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