Prostate cancer

30 Prostate cancer





Questions



image How may prostate cancer present?

image Under what conditions would prostate specific antigen (PSA) be raised?

image What are the alternatives to surgery for prostate cancer?

Prostate cancer is the most frequently diagnosed cancer in men, and the leading cause of cancer-specific deaths in men. It may be asymptomatic, and postmortem studies show that 80% of men over 80 years die with prostate cancer, but not necessarily of it. The 5-year survival is 80% with localized disease but 20–30% if metastases are present.




Aetiology


Generally prostate cancer is dependent on androgens (testosterone) for growth. The incidence is higher in African-Americans than in Europeans, and least frequent in Asians. Genetic factors play a role in 10% of cases, particularly in the young (initial mutation in chromosome 8).



Pathology


Prostate cancers are adenocarcinomas and typically grow around the periphery of the gland. They are staged based on the histology of the cancer (Fig. 3.30.1).


image

Fig. 3.30.1 The prostate in cross-section.



Clinical features


The main symptoms are:


image prostate specific antigen (PSA) screening/testing

image bone pain caused by metastatic deposits: the first presentation of prostate cancer in 30% of men; the diagnosis of prostate cancer should be considered in an elderly man presenting with recent-onset lower back pain (also look for weight loss, lethargy and anaemia)

image lower urinary tract symptoms: if the prostate grows large enough, it may cause bladder outflow obstruction symptoms (as in Ch. 29). Thus for patients with benign prostatic hyperplasia (BPH), prostate cancer screening with PSA can be considered.

A tumour may be an incidental finding while performing transurethral resection of the prostate to treat suspected benign prostatic hyperplasia (10%).



Investigations




Digital rectal examination


The patient lies on one side for the examination (Fig. 3.30.2). An enlarged, hard and craggy prostate suggests cancer.


image

Fig. 3.30.2 Digital rectal examination of the prostate.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Prostate cancer

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