Prostate Cancer

Prostate cancer is one of the most common forms of cancer and the commonest cause of death in case of males


Risk Factors Of Prostate Cancer

  1. Advancing age (Over 80 years)
  2. Family history 
  3. Race – North American Blacks have higher incidence
  4. Dietary fat
  5. Smoking and alcohol
  6. Hormones 
 
Management Of Prostate Cancer
Presentation
  1. Lower urinary tract symptoms
  2. Back pain 
  3. Hematuria
  4. Urinary retention (Acute or chronic)
  5. Erectile dysfunction
  6. Due to spread of the tumor
    • Direct spread
      • Haematospermia
      • Haematuria 
      • Loin pain 
      • Perianal pain 
      • Impotence 
    • Haematogenous spread
      • Bone – Lower back pain, mainly osteosclerotic changes, pathological fracture
      • Liver – Jaundice, hepatomegaly
      • Lungs – Persistent cough, haemoptysis 
      • Brain – Early morning headache and vomiting 

Examination
  1. Anaemia
  2. Cachexia
  3. Bony tenderness
  4. Palpable bladder (If bladder neck is obstructed)
  5. Lymphadenopathy
  6. DRE
    • Enlarged prostate
    • Asymmetrical 
    • Irregular / Nodular surface 
    • Consistency – Hard
    • Obliteration of median sulcus
    • Fixed overlying mucosa 
 
Investigations
  1. Prostate specific antigen 
    • It is a glyprotein produced by prostatic epithelium 
    • < 4ng/mL is normal 
    • If > 10ng/mL – Prostatic biospy 
    • If > 20ng/mL – Bone scan
  2. Transrectal ultrasound and tru-cut biopsy
    • Minimum 8 samples from 4 different quadrants 
  3. For metastasis 
    1. X-Ray of lumbosacral spine and pelvis
    2. Bone scan 
    3. Ultrasonography of abdomen 
    4. CT scan of abdomen and thorax 
    5. Chest X-Ray  
Treatment 
  • Localized disease – Life expectancy is 10 years
    1. Watchful waiting 
      • Old patients with low grade carcinoma 
      • Regular follow up : 6 monthly (DRE, PSA, Transrectal ultrasound scan  
    2. Radiotherapy (External, brachytherapy)
    3. Surgery – Radical prostatectomy with sampling of pelvic lymph nodes 
  • Locally advanced disease – Life expectancy is 5 years 
    1. Radiotherapy (External, brachytherapy)
    2. Hormonal treatment 
    3. Channel TURP (Symptomatic patients)
  • Metastatic disease – Life expectancy is 2 years
    1. Orchidectomy : Surgical castration (For older patients)
    2. Oestrogens – Diethyl stilboesterol (For younger patients)
    3. LHRH agonist : Medical castration 
    4. Anti-androgens 
      • Steroidal anti-androgens – Cyproterone acetate
      • Non steroidal anti-androgens – Finastride, flutamide 
 
 
Spread Of Prostate Cancer

  1. Local / Direct spread
    • It involves seminal vesicles, bladder neck, ureter, urethra, nerves 
    • Haematospermia
    • Haematuria 
    • Loin pain 
    • Perianal pain 
    • Impotence
  2. Lymphatic spread
    • Internal iliac lymphnodes
    • Extenal iliac lymphnodes
    • Retroperitoneal lymphnodes 
  3. Haematogenous spread
    • Bone – Lower back pain, mainly osteosclerotic changes, pathological fracture
    • Liver – Jaundice, hepatomegaly
    • Lungs – Persistent cough, haemoptysis 
    • Brain – Early morning headache and vomiting 
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Maxwell Jennifer
2 years ago

Thanks for sharing this nice blog. Today Neck and back pain is a common issue.Yoga and some home treatments really good for health. But if you are suffering from this type of pain from long time, then don't be delay. It can be make a big issue for your health. Back Pain Management

Unknown
2 years ago

Prostatitis is a painful prostate gland disorder that commonly affects young and middle aged men. It may be difficult for doctors to diagnose prostatitis because many of the symptoms, such as burning feeling while urinating and incomplete emptying of the bladder could be signs of another urinary problem. Complications may reduce by taking prostatitis disease treatment.