22 Psychiatric Medications for Monitoring in Primary Care Medication Warnings, Precautions, and Adverse Events Comments Class: SSRI Fluvoxamine Used much less than SSRIs in the group of eight medications for prescribing, probably because it has no Warnings and Precautions: Similar to other SSRIs FDA indication for MDD or any anxiety disorder. Still Adverse Events: Sim
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In American men, prostate cancer is the most common cancer (other than skin cancer) and the second leading
cause of cancer death. The prostate gland is walnut-sized and is located in front of the rectum, behind the penis,
and under the bladder. It makes some of the seminal fluid, which protects and nourishes sperm cells in semen.
Most prostate cancers grow very slowly, but when they spread, they can do so quickly. Most early cases of pros-
tate cancer cause no symptoms, but some early signs may be frequent urination, especially at night; blood in
urine; difficulty starting urination or inability to urinate; and weak or painful urination. However, these symp-
toms may be signs of other conditions. Men who experience these symptoms should see a doctor.
Prevention Although the causes of prostate cancer are not yet completely understood, researchers have found
several factors that increase the risk of developing the disease. Many risk factors, such as a man’s age, race,
and family history, are beyond his control, but since high-fat diets have been linked to prostate cancer, eating
a diet that is low in saturated fat and red meats and high in fruits and vegetables may help reduce a man’s risk
for developing the disease. In large clinical trials, drugs such as finasteride and dutasteride have been shown to
lower prostate cancer risk, although these medicines are not without side effects.
Detection At this time, there is insufficient evidence to recommend for or against routine prostate cancer
screening for average-risk men. For this reason, the American Cancer Society does not recommend routine
screening for prostate cancer. Rather, the American Cancer Society recommends average-risk men, beginning at
age 50, have the opportunity to make an informed decision about screening after discussing the potential benefits
and limitations of prostate cancer early detection testing with a health care professional. Men at higher risk,
including African American men and men with a first-degree relative diagnosed with prostate cancer before
age 65, should have this conversation with their doctor beginning at age 45. Men at even higher risk (because
they have several close relatives diagnosed with prostate cancer at an early age) should have this discussion
with their doctor at age 40. If a man chooses to be tested, the recommended test is the prostate-specific antigen
(PSA) test with or without the digital rectal exam (DRE).
Treatment If prostate cancer is found early, treatment with curative intent is often initiated. Such treatment
usually consists of either radical prostatectomy (surgical removal of the prostate gland) or radiation treatment
(of which there are multiple forms). If the cancer is believed to be slow growing and is not causing symptoms,
“watchful waiting” may be chosen initially, especially for older men. Active treatment will be started later if the
cancer begins to grow more quickly or symptoms appear. For cancer that has spread beyond the prostate gland,
treatments such as hormone therapy, chemotherapy, and/or immunotherapy may be recommended. Each of the
surgical and nonsurgical treatments has side effects that should be considered when deciding how to proceed.
The five-year relative survival rate represents the
percentage of patients who live at least five years after
diagnosis, whether disease-free, in remission, or under
Prostate cancer in
treatment (after adjusting for people who die of other the United States:
causes). It does not imply that five-year survivors have 2010 estimates
been permanently cured of cancer. Localized cancer is cancer that, at the time of diagnosis, had not spread to additional sites within the body. Typically, the earlier cancer is found and diagnosed, the more successful the • Five-year relative survival rate treatment, thus enhancing the survival rate. Prostate cancer is usually detected before it spreads. • Five-year relative survival rate The five-year relative survival rate for early prostate cancer is very high with or without treatment (near • Ten-year relative survival rate 100%). If the cancer has spread by the time it is detected, Who is at risk?
Gender Only men are at risk.
Age Although men of any age can get prostate cancer, the chance of having it increases rapidly after age 50.
More than 60% of all prostate cancers are diagnosed in men older than 65.
Racial/Ethnic background African American men and Jamaican men of African descent have the highest
documented prostate cancer incidence rates in the world. Furthermore, in the United States, the prostate cancer
death rate for African American men is more than twice the rate for white men.
Other risk factors
Heredity Genetic studies suggest that 5% to 10% of prostate cancers may be inherited.
Diet A high-fat diet may play a part in causing prostate cancer. The American Cancer Society recommends a
diet that is low in saturated fat (mainly found in animal sources, such as red meat and dairy products), and high
in fruits and vegetables.
From the time of diagnosis, the quality of life for every cancer patient and survivor is affected in some way. The
American Cancer Society has identified four quality-of-life factors that affect cancer patients and their families;
these factors are social, psychological, physical, and spiritual.
The concerns that patients and survivors most often express are fear of recurrence; chronic and/or acute pain; sexual problems; fatigue; guilt for delaying screening or treatment, or for doing things that may have caused the cancer; changes in physical appearance; depression; sleep difficulties; changes in what they are able to do after treatment; and the burden on finances and loved ones. For prostate cancer patients and survivors, quality-of-life concerns most often revolve around the potential for incontinence and sexual dysfunction. In recent years, the quality of life for those who are living with cancer has received increased attention. The American Cancer Society offers an online community for people with cancer and their families and friends so they don’t have to face their cancer experience alone. To participate in the Society’s Cancer Survivors NetworkSM, visit http://csn.cancer.org. There are also support programs and educational sessions for men with prostate cancer, such as the American Cancer Society Man To Man® program. These programs give men with prostate cancer a place to share information, and they offer support. For more information about Man To Man or other Society programs, call 1-800-227-2345. Emerging trends
Emerging trends in the area of prostate cancer research include:
Basic research Little is known about how to prevent prostate cancer. Additionally, doctors are uncertain as to
which prostate cancers will be fast growing and need aggressive treatment, or which will be slow growing and
need less aggressive treatment. Therefore, research is focusing on better ways to prevent the disease and identify
how it grows.
Genetics Genetic research is seeking to identify men at highest risk for prostate cancer, so screening may begin
earlier. Research on genes may also make it possible to design medications and treatments to reverse the changes
that lead to prostate cancer.
Prevention Research continues to look at foods, such as tomatoes and soybeans, that may reduce the risk
of prostate cancer. New drugs that block the effects of male hormones, which may promote prostate cancer
growth, are being developed.
Vaccines Several types of vaccines for increasing the body’s immunity to prostate cancer cells are being tested.
A vaccine known as sipuleucel-T (Provenge) is now approved for use in some men with advanced prostate cancer.
To learn more about prostate cancer and the American Cancer Society’s resources and programs, please call our toll-free number at 1-800-227-2345 or visit our Web site at www.cancer.org.
Additional information on prostate cancer may be found at: • National Cancer Institute
• Prostate Cancer Foundation
Cancer Information Service
• ZERO – The Project to End Prostate Cancer
• American Urological Association
Age and gender are the main risk factors for developing prostate cancer. Detecting prostate cancer
in an earlier, more treatable form may increase the success of treatments and survival. All men 50
and older should talk to their doctors about the risks and benefits of prostate testing to decide
if it’s right for them. Men diagnosed with prostate cancer should discuss all available treatment
options with their doctor, especially since it is not clear whether all men need to be treated
immediately for prostate cancer.
2007, American Cancer Society, Inc.
No.300204-Rev.07/10Models used for illustrative purposes only.
Publikationsverzeichnis Prof. Dr. med. Anita Rauch A) Originalarbeiten 108. Göhring I, Tagariello A, Endele S, Stolt CC, Ghassibé M, Fisher M, Thiel CT, Trautmann U, Vikkula M, Winterpacht A, FitzPatrick DR, Rauch A (2009) Disruption of ST5 is associated with mental-retardation and multiple congenital anomalies. J Med Genet, in press 107. Segel R, Levy-Lahad E, Pasutto F, Picard