Prostate Cancer : The Man Killer

Prostate health is one of the most important aspects of a man’s health. Prostate health is something that should be treated with a balanced diet your whole life. Prostate cancer is VERY serious and will kill you if not diagnosed early and treated. Prostate cancer is a condition where prostate cells grow exponentially and out of control. It is the most common cancer associated with men, and can lead to many complications, one rather large one being that you die. 


Since prostate cancer is one of the most common forms of cancer in men, every man should consider trying to improve the health of this vital gland
naturally through diet and supplements. The idea of eating for a healthy heart is now medically accepted ­ but the concept of eating for a healthy
prostate is revolutionary.

Afflictions of the prostate are most commonly found in developed countries whose dietary habits focus on red meat and dairy products. Eastern males eat many more yellow, orange, red and green vegetables (such as red, yellow and green peppers, broccoli, spinach, etc. A recent Harvard study, among others, found that diets high in lycopene-rich tomatoes, tomato products and other lycopene-rich sources have been shown to be associated with a lowered risk of developing prostate cancer. 

Dietary fiber derived from beans, lentils and peas in high quantities have been associated with decreasing prostate cancer risks while promoting prostate health. The main component associated with prostate cancer is fat. A diet low in animal meat may decrease your risk for developing prostate and other cancers. Maintaining a healthy prostate is easy enough these days with all of the dietary supplements and herbal pills now available. 

Each year thousands of men are treated for inflamed prostates, in most cases those cases of prostatitis could have been prevented with the help of
supplements for prostate health. Supplements for prostate health are not meant to cure disorders, but they can help strengthen a man's resistance
against these conditions.  Most supplements for prostate health are found in ordinary natural foods that people can easily get their hands on. Herbal
remedies have long been found effective as supplements for prostate health.

In the past few years, supplements for prostate health have been made available to help men minimize their chances of developing any of these disorders. Even though these supplements cannot cure cancer, they can help in developing the defenses of men against prostate disorders. In fact, a range of dietary supplements and herbal medicines offers new ways to prevent or treat prostate disease, and cancer in general. 

Prostate health is simply nothing to ignore and finally… you don’t have to. Prostate health is one of the most important concerns for men, and each
man should have a yearly check of their prostate health after a certain age. Natural prostate health is the best choice that many men are making today to ensure their health, since natural health is about taking care of your body as a whole. Prostacet is a super prostate formula and the best supplement to give your body all that it needs to help you in reducing your risk for prostate cancer.

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Prostate Cancer – Morality vs. Science

With such widespread diseases as prostate and various other forms of cancer, there are concerns which eventually arise about the treatments and tests for such illnesses. Because such illnesses are so prevalent in developed countries, diseases like cancers and diabetes are widely studied by research institutions all over the world in hopes that there will be better cures and quicker tests to determine if someone has the illness or not. However, by developing such treatments, preventative measures and genetic tests, people fall into the problem of what constitutes morality. For illnesses like prostate cancer, morality is on the verge of being sent to the wayside in an effort to allow high risk individuals to be tested for the prostate cancer gene long before they reach the age in which prostate cancer will spring up within their bodies. 


Perhaps the biggest debate over prostate cancer morality is whether or not scientists should develop early screening tests for the illness in high risk patients. Due to the extremely high genetic correlation between those affected by prostate cancer and the probability of their children getting the disease when they are older, a genetic test would be an excellent way to help people realize if they will have prostate cancer in the future or not. 

Unfortunately for the technologies which could ultimately screen for prostate cancer, morality soon enters the debate. If people find out when they are young that they will have a high risk for prostate cancer at age sixty or so, they may have a slightly traumatic experience growing up and feeling that they will die at around age sixty – especially if there is no cure for prostate cancer by that time.  Furthermore, they would have difficulty finding health insurance – as no self respecting insurance agency will want to insure a person who will be catching a costly disease at age sixty. These are two major concerns from a point of prostate cancer morality.

On the opposite side of the argument, however, people who say that prostate cancer morality should take a back seat to scientific advancement proclaim the benefits of early genetic testing. People should be aware of the status of their health. If more people were to receive blood tests to determine if they are at risk for prostate cancer, they would go get more prostate exams which would in turn lower the mortality rate for prostate cancer. After all, it is pretty difficult for those who support prostate cancer morality to argue against less people dying.

The whole battle between prostate cancer morality and the necessary science to help cure people will certainly turn into a raging debate in the future. Ultimately, the outcome will determine how well we handle other emerging diseases and whether or not we will do whatever it takes to combat them.

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Prostate Cancer

Etiology of prostate cancer development is not completely known. Factors that can influence the creation and development of this type of cancer include:


genetic factors – increase in risk of falling ill among men with a positive family history regarding the prostate cancer. Mutations of suppressor genes are also taken into consideration (p53)

dietetic factors – food rich in saturated fatty acids probably increases the risk of falling ill whereas the consumption of soya and rice may have a beneficial protective effect racial and geographical factors – Afro-Americans are 100% more likely to fall ill, whereas the lowest death rate is reported in Japan and in China

occupational factors – cancerogenous influence of heavy metals and toxins infectious factors – viral infection may lead to/ be the cause of anaplasia of adenocyte cells of prostate

Histopathologically, 95% prostate cancer cases occur in the form of adenocarcinoma. Other types (primary intracellular cancer, squamous carcinoma, anaplastic carcinoma, and sarcoma) are rarely met. Adenocarcinoma usually develops in the peripheral area of the prostate (85%), in the transition area (25% ) and in the central area (5%).

Symptoms

In symptomatology of the prostate cancer, 4 clinical forms are distinguished:

1) visible form with distinct pathological symptoms 2) latent form (carcinoma latens) with no distinct pathological symptoms found 3) hidden form (ca occultum) which is detected in the case of distinct ailments caused by the existence of remote metastases, however changes in prostate are not found in the course of per rectum examination 4) accidentally detected form - based on histopathological test of the gland that was removed because of prostate overgrowth, or based on biochemical tests (PSA) During the development of prostate cancer, an induction phase that lasts about 30 years  which is clinically invisible can be distinguished. During the next stage - in situ phase (5-10 years) and invasive phase (1 year), ailments connected with the local growth of tumour start to appear. During this period, symptoms connected with sub bladder obstacle appear including mainly: -  pallakiuria - nycturia - weak urine stream - painful vesical tenesmus - impression of incompletion of bladder emptying The above-mentioned symptoms are typical of cancer and in some cases they may suggest mild overgrowth of prostate, or neurogenic or athermatous bladder disorders. During the dissemination phase (about 5 years), prostate cancer develops continuously infiltrating surrounding organs, such as: urinary bladder, rectum, ureters, pelvic walls and leading to urinary retention in kidneys and to secondary failure of function. Ailments typical for this period include: - haematuria - dysuria - urinary incontinence - erection disorders - aches of perineum, lumbar area and anus - haematospermia Metastases spread through the lymphatic vessels and the vascular system. Symptoms caused by the existence of remote metastases are as follows: - osteodynia and pathological fractures - pressure symptoms and spinal paralysis - lymphadema of limbs - clotting disorders - cachexy - coma

DIAGNOSTICS

In order to diagnose the prostate cancer, patient should undergo per rectum tests (DRE), PSA concentration (prostate specific antigen) in blood serum should be determined, ultrasonography per rectum examination (TRUS - transrectal ultrasound) should be done and if there is a suspicion of prostate cancer, histopathological test of the material obtained through a per rectum thick-needle biopsy done under the ultrasound control should take place. Histopathological test is the only test that confirms the presence of cancerous cells in the prostate gland area. DRE, which is an examination of sensitivity of 80% sensitivity and of specificity of 60%, enables to seize changes in the area of the prostate such as consistency change, palpable nodules and hardenings. It is the base for sending a patient to a diagnostic biopsy. At present, it is believed that cytological diagnosis achieved through a fine-needle biopsy is not sufficient to make a right diagnosis. It results from the fact that the assessment according to Gleason’s classification is an important prognostic factor for the prostate cancer (see: prognostic factors). That is why a thick-needle biopsy is performed. Ultrasound use enables to take precise samples from suspicious foci. If there are no changes in TRUS picture, "sextant biopsy" is done (samples got for several places).

Recommendations for the biopsy of prostate gland: 1) palpable suspicion of the prostate cancer 2) PSA value over 15ng/ml regardless of DRE or TRUS tests 3) PSA value between 4 and 15 ng/ml with abnormalities detected during DRE or TRUS tests 4) PSA value exceeds the norm for a given age in the case of a positive family history regarding the prostate cancer

Recommendations for TRUS: 1) PSA between 4 and 12 ng/ml with abnormalities detected 2) questionable result of DRE test 3) necessity of  a thick-needle biopsy Other diagnostic tests, such as CT and urography are not routinely performed because their value is questionable as far as the assessment of local stage and invasion of adjacent lymph nodes is concerned. Nowadays, magnetic resonance tomography done using transrectal coli (endorectal coil MRI - ERMR) to observe the prostate arouses great interest. Despite the increased sensitivity of the degree of the local stage, costs of the test do not allow for its routine use in the prostate cancer diagnosis. Scintigraphy of the skeleton is the most sensitive test (97%) in bone metastases detection. It is assumed that a patient with PSA under 10 ng/ml does not undergo scintigraphy because the probability of metastases is low.

Screening:

Screening:  It is recommended that patients aged over 50 should undergo per rectum tests and PSA level tests every year.

PROGNOSTIC FACTORS:

Three groups of prognostic factors can be distinguished in the case of the prostate cancer:

1) development stage according to TNM 2) differentiation degree of the cancer based on the classification of Gleason and Mostofi 3) PSA level (prostate-specific antigen) in serum TNM classification

Preoperative assessment of the stage of the prostate cancer is made based on the above-mentioned tests.

T-stage: primary tumour

Tx - primary tumour cannot be assessed T0 - no evidence of primary tumour T1 - clinically unapparent tumour; not palpable or visible by per rectum imaging T1a - incidental tumour found in histopathological tests after transurethral resection of the prostate or after operational adenectomy: found in 5% or less resected tissue T1b - as above; found in more than 5% resected tissue T1c - tumour identified histopathologically by a needle biopsy (because of high PSA) T2 - tumour confined within the prostate gland T2a - tumour involves less than half of one lobe T2b - tumour involves more than half of one lobe only T2c - tumour involves both lobes T3 - tumour extends through the prostatic capsule T3a - extracapsular extensions (unilateral) T3b - extracapsular extensions (bilateral) T3c - tumour invades seminal vesicles T4 - tumour is fixed, invades adjacent structures other than seminal vesicles T4a - tumour invades bladder neck and/or external sphincter and/or rectum T4b - tumour invades levator muscles and/or pelvic wall N-stage: regional lymph nodes

Nx - regional lymph nodes cannot be assessed N0 - no regional lymph node metastases N1 - metastasis to a single regional lymph node with the diameter under 2cm N2 - metastasis to a single regional lymph node with the diameter > 2cm but < 5cm N3 - metastases to regional lymph nodes with the diameter over 5cm M-stage: remote metastases

Mx - remote metastasis cannot be assessed M0 - no remote metastases M1 - remote metastases M1a - non-regional lymph nodes M1b - bones M1c - other sites According to Whitmor-Catalon classification, grades A, B, C, and D correspond to T1, T2, T3 and T4 of TNM classification respectively.

Degree of cancer differentiation:

Degree of differentiation is defined according to 2 classifications: by Mostofi and by Gleason.

Mostofi’s classification uses a 3-grade assessment of differentiation dependent on the degree of cell anaplasia – grading (G1-G3). The higher grade, the lower differentiation of cancer tissue, the greater atypy and at the same time, malignancy. In the case of a 10-grade Gleason system, the two extreme histological images in the preparation are assessed and then, added to produce a final grade.

PSA is a proteolyctic enzyme responsible for sperm melting. It is mainly produced by glandular epithelium, it might be also produced in organs such as salivary glands, pancreas and mammary gland and by clear cell carcinoma. Commonly used norm is the following: 0-4 ng/ml. Such concentration of PSA is found among 97% of men over 40. The level over 12 ng/ml is always connected with pathology. Difficulties with diagnosis are found among patients who have this level between 5-10 ng/ml because it may both stem from the prostate cancer or a mild overgrowth of the prostate, which causes the necessity of diagnostic methods use, such as TRUS. This test makes it possible to determine PSA density (PSAD - PSA density) - PSA concentration converted to prostate volume unit. It should be under 0.15 ng/ml/g. In the case of prostate cancer differentiation and mild overgrowth of prostate, free to total PSA (PSA F/T) is used. If it is over 20%, one may assume the presence of cancerous cells in the gland. PSA level does not correlate well enough with the natural development of the prostate cancer. However, it is useful as a prognostic factor after the treatment applied and in prognosis determination. However, high final levels indicate low survival rate.

TREATMENT

Proceeding strategy in patients with the prostate cancer depends on the degree of histological malignancy, the degree of local stage of development, coexisting diseases and age of a patient. There are many controversies as far as the choice of treatment is concerned. Radical treatment is possible in T1, T2 and N0 and Mo stages. In advanced cases (T3, T4, N-+, M-+), the procedure is restricted to delay the cancer progression and mitigate its effects (palliative treatment).

Surgery treatment - radical prostatectomy

The surgery consists in the prostate gland removal together with spermatic vesicles and adjacent tissues. Surgery is done through retropubic, transcoccgeal, perineal approach or through laparoscopy. Lymphadenectomy constitutes an integral part of the surgery. If the approach makes it impossible to remove the gland and lymph nodes (perineal approach) at the same time, a separate surgery is carried out. It precedes the operation proper. It is believed that cancerous cells found in the removed lymph nodes are the reason why prostatectomy cannot be performed. Invasion of lymph nodes to a certain extent suggests PSA level over 40ng/ml together with grade >7 in Gleason’s scale.

Recommendations for surgery:

1) cancer limited to the prostate gland (T1BN0M0Gx - T2N0M0Gx, T1AN0M0G3) 2) predictable life span over 10 years 3) consent of a patient If positive chirurgical margins, capsule infiltration or cancerous changes in the removed lymph nodes are found in postoperative microscopic assessment, the prognosis is worse – such patients are qualified for palliative treatment. The death rate in the postoperative period does not exceed 5%. Intraoperative complications first of all include: bleeding from Santorini’s plexus, damage of rectum wall, underpinning of ureter. Early complications after surgery: thrombotic and embolic complications (phlebothrombosis 3-12%, lung embolism 2-5%) and lymphocele. Late postoperative complications after prostatectomy include: urinary incontinence, erection disorders and narrowing of urethro-vesicular junction).

Radiotherapy

Apart from radical prostatectomy, radiotherapy is an effective method of treatment for patients with regional advanced prostate cancer. In radical treatment, the most frequently done using radiation from external sources, the dose of 50-70 Gy in fractions continuing over 5-7 weeks are given. T1ABC - T2ABCG1 and T1ABCG2 stages require radiation limited to the prostate. In other cases, area that is radiated includes adjacent lymph nodes as well.  In recent years, multidimensional imaging with CT (3D conformal radiotherapy) is used in the treatment planning.

Brachytherapy constitutes another method that is used.

Recommendations for radical radiotherapy of the prostate:

1) prostate cancer confined with the organ 2) sufficiently long predictable survival span 3) no disorders in lower urinary tract 4) no disorders in rectum and colon 5) consent of patient to carry out treatment 6) early complications of radiation energy treatment (30% of patients) include dysuria, haematuria, diarrhoea, rectal tenesmus, inflammation of large intestine and rectum. Among later complications (11% of patients) chronic diarrhea, ulceration of rectum, bladder neck stenosis and intestinal fistula stenosis are observed.

Control of patients after radical prostatectomy and radical radiotherapy:

-   per rectum test, PSA level in blood serum each 3 months. PSA level should be lower than 1 ng/ml (after radical prostatectomy it should be near to 0). Increase over 0.5 ng/ml within a year means failure of radiotherapy. Hormonotherapy

Hormonal therapy is mainly used as palliative treatment in advanced prostate cancer. It makes it possible to stop symptoms of the disease for some time and then, further progression of the disease takes place. Nowadays, the use of therapy in pulsation system is considered as it delays the development of hormone-resistant cell clones.

Ways of hormonal treatment include: 1) surgery castration (orchidectomy) 2) anti-androgens a) non-steroid   b) steroid 3) analogues LH-RH 4) oestrogens, progestogens, inhibitors of androgens synthetase Hormonotherapy by analogues LH-RH is also recommended before planned radical radiotherapy. In the case of hormone-resistant cancer, treatment with combined cytoctatic and hormone (estramustine), however without significant effects.

PROGNOSIS

Prognosis depends on the development stage, degree of differentiation and PSA level (see: prognostic factors).

In T1A, B stage prognosis is good. 10-years survival 35-80%, death rate of the cancer 7-30%. In T2 stage, overall survival equals 34-85%, death rate equals 8-26%. In T3 stage, among patients who undergo non-invasive treatment for 9 years, overall death rate equalled 63%, from cancer – 30%. Depending on the degree of cancer differentiation, 10-year survival of patients is the following: for cells well differentiated - 81%, for cells moderately differentiated - 58% and for cells poorly differentiated - 26%.

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New Study Examines Antioxidant Impact on Prostate Cancer

Prostate cancer as one of the most common types of cancer in men according to the American Cancer Society. Fortunately if caught early, the prognosis is good. Even better than treating it, is of course, avoiding it altogether. The search for the cause of prostate cancer is ongoing and a recent study was recently completed.


An eight year study of 29,361 men has just been completed. The study examined the impact of antioxidant supplements on the rate of prostate cancer. "There has been definite interest in their use, based on a few earlier studies that have been done" said lead researcher Richard B. Hayes, senior investigator in the division of cancer epidemiology and genetics at the U.S. National Cancer Institute.

Reporting in the Feb. 15 issue of the Journal of the National Cancer Institute, Hayes' team calculated the risk of prostate cancer for 29,361 men aged 55 to 74, all of whom were participants in the Prostate, Lung, Colorectal and Ovarian (PLCO) Screening Trial.

Some of the data that was analyzed included the amount of common antioxidant supplements including vitamin C, beta carotene, and vitamin E. Some of the men had been taking these supplements for many years prior to the study.

Over the total eight year study period, 1,338 men developed prostate cancer. The results indicate that the use of antioxidant supplements had no positive impact on the risk for prostate cancer for most nonsmokers. Beta carotene supplements did have a positive impact among men that had low dietary intake of beta carotene.

Vitamin E did have a positive impact for smokers according to the research. This was consistent with previous trials.
Although the three supplements studied in this trial showed little help in preventing prostate cancer, previous trials that examined other supplements did show very encouraging results.

Fish oils, which contain EPA and DHA, were found to reduce prostate cancer by 11% in men that consumed about 470 mg./day. Selenium has been found to cut prostate cancer in half. Over five clinical trials have supported this. It is recommended that men take a 200 micrograms of selenium daily.

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Knowing Your Cancer Risk

Prostate cancer is the most common cancer among American men after skin cancer, according to the National Cancer Institute.


Based on this statistic, most people might assume that the majority of American men are well educated about how best to fight prostate cancer, where to turn for more information and what support group an uncle or golf buddy relied on during their respective battles with the disease.

Unfortunately, this is not the case. While women regularly host breast cancer awareness and fund-raising walks across the country, men have been less proactive on matters related to their health, including essential measures such as soliciting second opinions and researching treatment options. The result of this passive approach is that the average man does not always make good, informed decisions about his own health care.

A new program is encouraging men to alter their approach to health care, at least when it comes to battling prostate cancer. Us TOO International Prostate Cancer Education and Support Network, along with Y-ME National Breast Cancer Organization, have founded the "Partner's Program" to help men with prostate cancer and their partners face the diagnosis together, encourage them to seek information regarding treatment options, and ultimately, make more well-informed treatment decisions.

This program clearly responds to an unmet need. Recently, an Us TOO- and Y-ME-commissioned survey found that, although the majority of men with prostate cancer have heard of both surgery and radiation as treatment options, up to 38 percent don't know that other treatments, such as hormonal therapy, even exist. Even more alarming, less than 50 percent of men with prostate cancer take the time to get a second opinion on their diagnosis or proposed treatment. These facts are sure to concern anyone who loves a man at risk of developing prostate cancer.

The good news for wives and partners is the survey found that men don't want to face prostate cancer treatment choices alone, making a resource like the "Partner's Program" attractive for both men and women. While men are not typically as open as women on subjects such as prostate cancer, the survey found that almost 70 percent of men age 50 and older indicated that they would like their partner to play an active role in the process of choosing an appropriate course of therapy.

Now, with the help of the "Partner's Program," the average American man may become more proactive about his health.


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How to Fight Prostate Cancer

Over the past few years Prostate Cancer has been targeted by health authorities as the largest hidden killer of men over 45 years of age. Although there have been advances in education and general public awareness, men are still demonstrating reluctance to acknowledge the need for vigilance in their everyday lives.


There are a number of ways that men can reassure themselves however.

Here is a list of facts and suggestions collated from a number of sources that you should know about.

One in every 6 men will suffer from prostate problems in their lives. So there is no need to feel isolated or a victim. Just take action and get to a doctor quickly at the first sign.
It is almost certain that quick action will lead to successful recovery. The sooner you visit your doctor and get referred to a Urologist the better your chances of successful treatment.

There is hope for the future. In 2002, scientists at Liverpool University in the UK isolated the gene that promotes the spread of prostate cancer. This information is still being explored to hopefully produce new drugs which will assist treatment of Prostate cancer outside of the normal Chemotherapy regimes currently in use.

Dietary habits are the common thread in most of the literature about prostate cancer.

•    Dairy products should be eliminated and replaced by soya. Just a couple of glasses of soy milk a day can have dramatic effects.
•    Lyocopene contained in tomatoes is another factor showing up in studies as an effective preventative element of a prostate cancer fighting diet. Eating one moderately sized tomato a day also provides approximately 4 mg of lycopene. Other tomato products, such as an 8-ounce portion of tomato juice or tomato paste may provide up to 25 mg of lycopene. See www.naturalhealthlive.com/Lycopene.html
•    Other fruits and vegetables are also recommended, such as avocadoes, pumpkins, beans and carrots and green leafy vegetables like spinach.
•    Garlic, which seems to pop up in every preventative healthy diet plan is also recommended as it contains allicin, which decreases the proliferation of cancer cells.
•    Selenium which is found in garlic, tomatoes, and broccoli has also been shown to be effective.

Cut back on salt and seasonings as these have been linked to cancer.

Finally, green tea is a popular choice as a beverage so drink at least 6 cups a day.

All in all there are plenty of reasons to be positive about controlling the risk of contracting prostate Cancer. A healthy diet as outlined above, coupled with most others advocated by Dietician everywhere, will dramatically reduce your concerns and help you lead a normal healthy long life.

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Could Pomegranates Be The New Prostate Cancer Natural Cure?

Pomegranates have long been used in traditional folk remedies to treat sore throats, inflammation, and rheumatism. And recent scientific research has suggested they are also potentially effective in both preventing and treating prostate cancer.


One study, conducted on human prostate cancer cells in lab dishes, at the University of Wisconsin, found that there were dose dependant improvements. Another study at the same facility injected mice with human prostate cancer cells. These mice developed malignancies. Some mice were fed plain water, whilst two other groups of mice were given water mixed with different concentrations of pomegranate extract.

Those mice that had water only had tumors that grew much faster than the pomegranate and water groups. The quantities given to the mice were comparable to that which people might get if they drank pomegranate juice on a daily basis. And whilst pomegranate juice hasn't been tested on humans with prostate cancer yet, the results are very good.

The study did not indicate what aspects of pomegranate juice were responsible for slowing down prostate tumour growth. But the scientists involved did mention the antioxidant polyphenolic compounds, which are more effective than green tea and red wine.

Pomegranate extract not only inhibited the growth of cancer cells, it also worked by another means - apoptosis.

Apoptosis refers to a way that cells can die. Cancer growths are characterized by an uncontrolled growth of cells that do not follow the normal processes of cellular differentiation of regular, healthy cells. Cellular differentiation means that the characteristics of a cell change and get the functions that a mature, healthy cell would. For example, liver cells have specialized liver functions, as do prostate, breast, kidney, and all other types of cells. This is normal and healthy.

In tumour growths, although some cells fully differentiate, many only differentiate partially, and some not at all. And the tumors which have more undifferentiated cells grow faster. So, inducing cellular differentiation is one approach to cancer treatment. The other two ways that doctors and researchers try to treat cancer is by causing the death of cancerous cells. They do this through apoptosis, mentioned above, and necrosis.

In apoptosis, cell death is programmed into the cell when it is 'born'. So the cell dies in a more natural way that is less destructive on its environment. By this I mean it doesn't cause inflammation and the damage associated with it to neighboring cells that may be healthy. Cells die either when they reach cellular old age or when their death benefits the body as a whole. Necrosis, on the other hand, does cause inflammation.

Generally, prostate cancer grows very slowly, although it is unpredictable and can grow quickly and spread.

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