cancer

Chapter 29 Prostatic cancer

What are its clinical and pathological features?

Prostatic cancer is one of the most common forms of malignancy among males. The incidence has apparently increased in recent years although this may be at least partly reflect increased diagnosis of early cancer within screening programmes. The disease primarily affects men in their sixth to ninth decades but may also occur in younger individuals.

Aetiological factors

The precise aetiology of prostate cancer has not yet been determined. However, increased exposure of prostatic epithelium to circulating oestrogens, as occurs in late middle-aged and elderly men, is believed to be an important factor in cancer development.

Prostate cancer may present with bladder outflow obstruction as a result of the prostatic enlargement (Fig. 3.29.1) and may be diagnosed incidentally during histological examination of tissue chippings removed at transurethral surgery for an enlarged prostate gland. Advanced cancer may present with metastatic disease (e.g. bone pain from skeletal metastases). An increasing number of patients are now diagnosed during specific screening for this disease (see below). Clinical examination in prostate cancer may reveal an asymmetrically enlarged firm prostate gland on digital rectal examination. Isotope bone scanning is commonly used to search for bony metastases.