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Prostate cancer - summarised

DEFINITION


Prostate Cancer is a cancer that occurs in a man’s prostate –a small walnut shaped gland that produces the seminal fluid that nourishes and transports sperm. It is one of the most common types of cancer in men as such much preventive measure should be put in place to avert the growth of prostate cancer.



RISK FACTORS


Increasing age, Family history, African origin, Dietary factors.



PROTECTIVE FACTORS


Nutritional factors have protective effect against prostate cancer, reduced fat intake, Soy protein, Lycopene, Vitamin E, Selenium, Race-Incidence doubled in African Americans compared to white Americans.



PROSTATE ANATOMY


Prostate lies below the bladder and encompasses the prostatic urethra, surrounded by a capsule and separated from the rectum by layer of fascia termed the Denonvilliers aponeurosis. Blood supply-Inferior vesical artery ad Nervous supply is derived from the pelvic plexus Important for erectile function.


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CLINICAL MANIFESTATIONS


Read more on Symptoms, Diagnosis and Treatment.

Early state (organ confined) and is asymptomatic


 - LOCALLY ADVANCED


Obstructive voiding symptoms, Hesitancy, Intermittent urinary stream, Decreased force of stream, May have growth into the urethra or bladder neck , Hematuria , Hematospermia . Advanced (spread to the regional pelvic lymph nodes), Edema of the lower extremities and pelvic and perineal discomfort.



- CLINICAL MANIFESTATIONS OF METASTASIS


Most commonly to bone (frequently asymptomatic) can cause severe and unremitting pain. Bone metastasis can result in pathologic fractures or Spinal cord compression. Visceral metastases (rare) can develop pulmonary, hepatic, pleural, peritoneal and central nervous system metastases late in the natural history or after hormonal therapies fail.



DETECTION AND DIAGNOSIS


PSA level is helpful in asymptomatic patients and more than > 60% of patients with prostate cancer are asymptomatic. Diagnosis is made solely because of an elevated screening PSA level. A palpable nodule on digital rectal examination is next most common clinical presentation and prompts biopsy. Much less commonly, patients are symptomatic. In advanced disease cases patients manifest with Obstructive voiding symptoms, Pelvic or perineal discomfort, Lower extremity edema and symptomatic bone lesions.


A digital rectal examination is of low sensitivity and specificity for diagnosis. However, a biopsy of a nodule or area of induration reveals cancer 50% of the time and that suggests that prostate biopsy should be undertaken in all men with palpable nodules.


The PSA level a better sensitivity but a low specificity, it indicates Benign prostatic hypertrophy and prostatitis . The PSA Velocity is a better measure of high risk patients. A rate >0.75/year increase warrants biopsy.



TREATMENT


          Surgery




  1. Traditional

  2. RoboticRadiation



  1. Brachytherapy

  2. External beam

    • Cryotherapy

    • Androgen Deprivation

    • Watchful waiting




RECOMMENDATIONS


It is recommended that PSA screening with direct rectal examination should be done




  1. Yearly after age 50 w/ 10 year life expectancy.

  2. May start at 45 w/ close relative w/ prostate cancer <65.


May start at 40 for multiple close relatives w/


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All about Prostate cancer - summarised was written by Dr LB Basaru. You can follow him on Social media. 

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