Prostate cancer: Are we close to knowing the disease?

Prostate cancer has become the major public health issue for men in the past decade. Prostate cancer incidences have increased in the past few years, although rates vary considerably across the world. More advanced technology to increase early detection rates must also be taken into consideration and have somewhat countered the increased rates of prostate cancer. Nevertheless, prostate cancer is the second most leading cause of death after lung cancer in both the UK and USA. Risk factors, include eating habits (e.g., fats vs. vegetables and antioxidants, vitamin D deficiency), race, sexual habits, and inherented genetic susceptibilities all contribute to prostate cancer rates. The exact causes of prostate cancer are unclear and promise to be complex. As in all other cancers, the development of prostate cancer is a multi-step process involving genes that govern cell growth and differentiation and their interaction with environmental and microenvironmental changes during life. Major host factors affecting the progression of prostate cancer include hormonal levels, androgen receptor (AR) and polymorphisms in AR, intracellular heat shock proteins, the extracellular heat shock factor, clusterin, and cell cycle regulators (e.g., cyclin A1). A prognosis of prostate cancer depends greatly on patient responses to androgen withdrawal therapy. Treatment options have varied greatly in the past decade and have matched our knowledge of the disease. For example, antisense therapies against proposed cancer stem cell targets, bcl-2, clusterin, or telomerase have been proposed. Treatments targeting tumour angiogenesis and metastasis, as well as more conventional chemotherapeutic or radiotherapeutic methods, are described. We focus on prostate cancer risk factors, causes, and progression and shed more light into some of the newer treatment modalities available.