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Adenocarcinoma of the Prostate

Prostate Adenocarcinoma

Adenocarcinoma of the prostate is histologically the commonest form of prostate malignancy. It is often asymptomatic until advanced or metastatic disease leads to symptoms of obstructive uropathy or bone pain respectively. Diagnosis depends upon digital rectal palpation, levels of prostate-specific antigen and prostate biopsy.


Presentation

Prostate cancer ranks the fifth in the list of the common causes of death in men suffering from cancer [1] [2]. The most prevalent histological form of prostate malignancy is an adenocarcinoma [3] [4]. Although widespread globally, it's incidence is high among the males of African descent in the United States [5].

Screening tests currently help to diagnose adenocarcinoma of the prostate before the onset of symptoms [6]. In addition, it is often asymptomatic as it grows slowly. Symptoms typically appear in advanced stages either due to urinary obstruction or metastasis. The main symptoms include increased frequency of urination, urinary hesitancy, weak urine stream, nocturia, urinary urgency, and hematuria. Renal dysfunction secondary to urinary obstruction or enlarged retroperitoneal lymph nodes may also be a presenting manifestation.

Symptoms like anorexia, loss of weight, backache, pain in the lower limbs, pain in the bones, and pathological bone fractures may be seen in some cases due to bone metastasis.

Splenomegaly
  • The transrectal ultrasound (TRUS) indicated an isoechonic and homogenic enlarged prostate of 42 cm3 and the abdomen ultrasound found a modest splenomegaly and no peripheral lymphadenophaty.[ncbi.nlm.nih.gov]
Weight Loss
  • Pancreas : Unintended weight loss, back and stomach pain, oily or light-colored stools, and itchy skin. Colon : A sensation that the bowels are full, bloody stool, rectal bleeding, stomach pain, and unexplained weight loss.[medicalnewstoday.com]
  • . • Symptoms of advanced disease with weight loss, lethargy, bladder outflow obstruction, or bone pain. Clinical presentation 7.[slideshare.net]
  • Ask your doctor for help creating a plan for healthy weight loss. Talk to your doctor about increased risk of prostate cancer. Men with a high risk of prostate cancer may consider medications or other treatments to reduce their risk.[mayoclinic.org]
  • loss Complications of the disease may also give rise to symptoms, such as urinary retention, pelvic pain, incontinence, or fractures related to bone metastases from prostate cancer.[verywell.com]
  • More widespread disease often spreads to the bones and gives pain or unexplained weight loss and fatigue.[cancer.org.au]
Suprapubic Pain
  • Perineal and suprapubic pain. Obstruction of ureters, causing loin pain, anuria, symptoms of acute kidney injury or chronic kidney disease. Impotence. Rectal symptoms - eg, tenesmus. Metastatic disease: Bone pain or sciatica.[patient.info]
Tenesmus
  • Rectal symptoms - eg, tenesmus. Metastatic disease: Bone pain or sciatica. Paraplegia secondary to spinal cord compression. Lymph node enlargement. Loin pain or anuria due to ureteric obstruction by lymph nodes. Lethargy (anaemia, uraemia).[patient.info]
Bone Pain
  • It is often asymptomatic until advanced or metastatic disease leads to symptoms of obstructive uropathy or bone pain respectively. Diagnosis depends upon digital rectal palpation, levels of prostate-specific antigen and prostate biopsy.[symptoma.com]
  • . • Symptoms of advanced disease with weight loss, lethargy, bladder outflow obstruction, or bone pain. Clinical presentation 7.[slideshare.net]
  • If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have signs of cancer spread in your bones.[webmd.com]
  • Managing bone pain and weakness Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.[healthline.com]
  • Prostate cancer that's more advanced may cause signs and symptoms such as: Trouble urinating Decreased force in the stream of urine Blood in semen Discomfort in the pelvic area Bone pain Erectile dysfunction When to see a doctor Make an appointment with[mayoclinic.org]
Urinary Incontinence
  • Both prostate cancer and its treatment can cause urinary incontinence. Treatment for incontinence depends on the type you have, how severe it is and the likelihood it will improve over time.[mayoclinic.org]
  • Relative side effects of different treatments Radical prostatectomy and brachytherapy result in higher rates of urinary incontinence and sexual dysfunction than EBRT.[myvmc.com]
  • incontinence fecal incontinence Treatment Treatment is different for early and advanced prostate cancers.[medicalnewstoday.com]
  • Adverse effects include bladder outlet obstruction, urinary incontinence, erectile dysfunction, and rectal pain or injury. Cryotherapy is not commonly the therapy of choice in the US but may be used if radiation therapy is unsuccessful.[merckmanuals.com]
Urinary Retention
  • CASE PRESENTATION: A 79-years-old white man, presented with acute urinary retention, had a peripheral blood count with an elevated lymphocytosis (21.250/mL) with a differential of 65.3% lymphocytes and the prostate-specific antigen (PSA) value was 3.38[ncbi.nlm.nih.gov]
  • retention, pelvic pain, incontinence, or fractures related to bone metastases from prostate cancer.[verywell.com]
  • Signs and symptoms Periurethral or centrally located ductal adenocarcinoma may cause haematuria, urinary urgency and eventually urinary retention. In these cases, there may be no abnormalities on rectal examination.[humpath.com]
  • The urinary tract obstruction leads to urinary retention and risk for infection. In severe, prolonged cases, hydroureter with hydronephrosis and renal failure can ensue.[library.med.utah.edu]
  • Hospitalisation (usually for urinary infections ) or urinary retention occur in less than 1% of cases. One study found the following complication rates: These symptoms were generally short term.[myvmc.com]
Nocturia
  • The main symptoms include increased frequency of urination, urinary hesitancy, weak urine stream, nocturia, urinary urgency, and hematuria.[symptoma.com]
  • Sciences , Lucknow, Uttar Pradesh , India Correspondence to Dr Aditi Arora, draditiarora87{at}gmail.com Statistics from Altmetric.com Description A 58-year-old man presented with history of irritative lower urinary tract symptoms (daytime frequency and nocturia[casereports.bmj.com]
  • […] gland is divided into several anatomic zones and prostate cancer usually arises within the peripheral zone near the rectum, which is why a digital rectal exam (DRE) is a useful screening test Clinically patients can present with: urinary symptoms, e.g. nocturia[radiopaedia.org]
  • Common symptoms include: Frequency of urination Urgency with urination The need to urinate at night (nocturia) Difficulty starting the stream of urine Decreased force of urination Less common symptoms may include: The sudden onset of erectile dysfunction[verywell.com]
  • BPH most commonly can present as urinary frequency, nocturia, and hesitancy. What is the current recommendation on prostate screening? This is a complicated answer.[unitypoint.org]
Enlargement of the Prostate
  • prostate nodular prostate polyp of prostate Type 1 Excludes benign neoplasms of prostate (adenoma, benign) (fibroadenoma) (fibroma) (myoma) ( D29.1 ) Type 2 Excludes malignant neoplasm of prostate ( C61 ) Adenocarcinoma - see also Neoplasm, malignant[icd10data.com]
  • The prostate may not be enlarged. Prostatic massage may increase the yield of urine culture. Routine cultures, however, do not identify one common organism: Ureaplasma urealyticum.[library.med.utah.edu]
  • Indeed, most, if not all of these can occur in men with noncancerous (benign) enlargement of the prostate (BPH), which is the more common form of prostate enlargement .[emedicinehealth.com]
  • Common problems are benign (noncancerous) enlargement of the prostate called BPH ( benign prostatic hyperplasia ), acute and chronic infections of the prostate (acute and chronic bacterial prostatitis ), and chronic inflammation of the prostate that is[medicinenet.com]
  • For patient education information, see the Men's Health Center and the Cancer Center, as well as Prostate Cancer, Enlarged Prostate (Benign Prostatic Hyperplasia or BPH), and Cancer: What You Need to Know.[emedicine.medscape.com]
Prostatic Disease
  • Featured Content Announcement To celebrate the Prostate Cancer and Prostatic Diseases satellite meeting in Shangai on 7 December 2018, Dr Stephen Freedland and Dr Dingwei Ye selected some of our top papers from China.[nature.com]
  • Garnick, editor of the Annual Report on Prostate Diseases, from Harvard Medical School. On the other hand, he adds, most high-grade prostate cancers are also born that way and will behave aggressively.[health.harvard.edu]
  • Although the chance of finding prostate cancer is over 50 percent, the benign prostatic disease does produce a marked increase in serum PSA in some men. Less than 0.2 ng/mL: After the prostate is surgically removed.[emedicinehealth.com]
  • Physical examination alone cannot reliably differentiate benign prostatic disease from cancer.[emedicine.medscape.com]

Workup

The workup of adenocarcinoma of the prostate commences with a detailed history and a digital rectal examination (DRE). Palpation of nodules or induration on DRE could indicate malignancy or prostatitis with seminal vesicle induration and restricted mobility of the prostate being suggestive of advanced prostate malignancy.

Laboratory tests like a complete blood count, renal function tests, acid phosphatase levels and prostate-specific antigen (PSA) levels are performed in all patients. PSA is a tumor marker [7] [8] [9] [10] [11] [12] [13] and high baseline levels are suggestive of a current or future likelihood of metastasis but it does not predict the risk of the disease. Elevated acid phosphatase levels are an indicator of poor prognosis although its levels could also be elevated after a prostate massage, in benign prostate hypertrophy (BPH) and some other disorders.

Confirmation of the diagnosis requires a biopsy with histology. The biopsy is typically obtained through an ultrasound directed transrectal approach. Multiple biopsies are taken from different sites and this helps to detect malignancy in patients with an elevated PSA level [6]. An ultrasound guided transperineal biopsy is preferred in patients in whom transrectal biopsy is likely to be associated with complications [14]. The Gleason score is used to define the histological differentiation of the tumor in the biopsy specimen [15] and is an indicator of tumor aggressiveness [16]. Well-differentiated tumors usually have a score less than or equal to six; moderately differentiated tumors have a score of 7 while poorly differentiated tumors are scored 8 -10.

Imaging studies like transrectal ultrasonography (TRUS), computed tomography (CT) scan, magnetic resonance imaging (MRI) and bone scan are used to detect local and distant spread and for staging adenocarcinoma of the prostate. Indium-111 capromab pendetide scanning and reverse transcriptase - polymerase chain reaction (PCR) assays for circulating prostate cancer cells are being studied as potential tools for staging and prognosis.

MRI Shows Cerebellar Atrophy
  • Here we report a 68year old man who developed progressive ataxia in the setting of stage D2 adenocarcinoma of the prostate and whose MRI showed cerebellar atrophy.[ncbi.nlm.nih.gov]
Prostatic Lesion
  • Colonoscopy, positron emission tomography, and other tumor surveys showed this to be the only prostate lesion. Microscopically, there was an adenocarcinoma with copious mucin production, with the formation of mucin pools.[ncbi.nlm.nih.gov]

Treatment

  • The association of treatment type and quality of life changes after treatment were evaluated with multivariate mixed model analysis, adjusting for age, time of quality of life assessment, and interaction between treatment and time.[ncbi.nlm.nih.gov]
  • Patient toxicity level was assessed by study and by treatment type combining RT only vs. RT short-course hormone therapy (STH) vs. RT long-term hormone therapy (LTH).[ncbi.nlm.nih.gov]
  • About 1 year before the cancer treatment, the patient also presented with sore and swollen hands, compatible with RS3PE, which remitted after a few months of prostatic cancer treatment.[ncbi.nlm.nih.gov]
  • A report of two patients in whom acute myelogenous leukemia (AML) developed after treatment with strontium-89 and a review of the literature are presented.[ncbi.nlm.nih.gov]
  • Subsequent treatment by orchidectomy caused tumour regression and remission of the syndrome. The patient remains well 9 months after the treatment.[ncbi.nlm.nih.gov]

Prognosis

  • The biologic behavior of this malignancy is not well understood and the prognosis is considered to be poor compared with typical adenocarcinoma of the prostate.[ncbi.nlm.nih.gov]
  • Elevated acid phosphatase levels are an indicator of poor prognosis although its levels could also be elevated after a prostate massage, in benign prostate hypertrophy (BPH) and some other disorders.[symptoma.com]
  • Prognosis of the classical type is worse than the adenocarcinoma of the prostate. Primary signet cell adenocarcinoma is diagnosed by eliminating the adenocarcinomas of other organs such as gastrointestinal tract organs.[ncbi.nlm.nih.gov]
  • The authors suggest that this condition may be more common than previously thought and, that in view of its good prognosis, may be a separate entity to chemotherapy-associated HUS in patients with cancer.[ncbi.nlm.nih.gov]
  • This variant of acinar adenocarcinoma is extremely rare and prognosis is poor. This entity has been included into the 2016 WHO classification. The principal differential diagnosis is urothelial carcinoma.[ncbi.nlm.nih.gov]

Etiology

  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • Etiology No specific etiologic factors have been defined for this particular type.[humpath.com]
  • Etiology, epidemiology, and natural history of benign prostatic hyperplasia. Urol Clin North Am. 2009;36:403-415. Demura T, Shinohara N, Tanaka M, et al.[library.med.utah.edu]
  • Environmental factors, notably diet, are also important (see Etiology ). Currently, the majority of prostate cancers are identified in patients who are asymptomatic.[emedicine.medscape.com]

Epidemiology

  • Author information 1 Department of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden. 2 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden. 3 Department of Pathology and Molecular Medicine[ncbi.nlm.nih.gov]
  • Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden[link.springer.com]
  • Epidemiology Geographical and Genetic Variations Australia has an incidence of prostate cancer of 100 per 100,000 people per year, making it the most common cancer of men. Mortality rates are significantly lower at about 17 per 100,000 per year.[ozradonc.wikidot.com]
  • Epidemiology of cancer in Indigenous Australians: Implications for service delivery.[myvmc.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Prostate cancer develops when the rates of cell division and cell death are no longer equal, leading to uncontrolled tumor growth.[emedicine.medscape.com]

Prevention

  • These data appear to suggest that dutasteride may delay or prevent progression of prostate cancer in some men with biochemical relapse after radical therapy. These findings require confirmation in the setting of a larger, longer trial.[ncbi.nlm.nih.gov]
  • Centers for Disease Control and Prevention. Division of Cancer Prevention and Control. (2011, August 31). Prostate Cancer Rates by Race and Ethnicity . Washington, DC: U.S. Government Printing Office.[cancergenome.nih.gov]
  • An antibiotic is often prescribed to help prevent an infection related to the procedure.[medicinenet.com]
  • Prevention You can reduce your risk of prostate cancer if you: Choose a healthy diet full of fruits and vegetables. Avoid high-fat foods and instead focus on choosing a variety of fruits, vegetables and whole grains.[mayoclinic.org]

References

Article

  1. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24(14):2137–2150.
  2. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.
  3. Sapira MK, Obiorah CC. Age and pathology of prostate cancer in South-Southern Nigeria; is there a pattern? Med J Malaysia. 2012;67(4):417–419.
  4. Ugare UG, Bassey IE, Jibrin PG, Ekanem IA. Analysis of Gleason grade and scores in 90 Nigerian Africans with prostate cancer during the period 1994 to 2004. Afr Health Sci. 2012;12(1):69–73.
  5. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.
  6. Zelefsky MJ, Eastham JA, Sartor AO. Cancer of the prostate. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins. 2011;1220-71.
  7. Matzkin H, Eber P, Todd B, et al. Prognostic significance of changes in prostate-specific markers after endocrine treatment of stage D2 prostatic cancer. Cancer. 1992; 70 (9): 2302-9
  8. Pisansky TM, Cha SS, Earle JD, et al. Prostate-specific antigen as a pretherapy prognostic factor in patients treated with radiation therapy for clinically localized prostate cancer. J Clin Oncol 1993; 11(11): 2158-66
  9. Carlton JC, Zagars GK, Oswald MJ. The role of serum prostatic acid phosphatase in the management of adenocarcinoma of the prostate with radiotherapy. Int J Radiat Oncol Biol Phys. 1990; 19 (6): 1383-8
  10. Stamey TA, Yang N, Hay AR, et al. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med. 1987; 317 (15): 909-16.
  11. Stamey TA, Kabalin JN. Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. I. Untreated patients. J Urol. 1989; 141 (5): 1070-5
  12. Stamey TA, Kabalin JN, McNeal JE, et al. Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. II. Radical prostatectomy treated patients. J Urol. 1989; 141 (5): 1076-83
  13. Andriole GL. Serum prostate-specific antigen: the most useful tumor marker. J Clin Oncol. 1992; 10 (8): 1205-7
  14. Webb JA, Shanmuganathan K, McLean A. Complications of ultrasound-guided transperineal prostate biopsy. A prospective study. Br J Urol. 1993; 72 (5 Pt 2): 775-7.
  15. Nnabugwu II, Udeh EI, Ugwumba FO, Ozoemena FO. Predicting Gleason score using the initial serum total prostate- specific antigen in black men with symptomatic prostate adenocarcinoma in Nigeria. Clin. Interv Aging. 2016;11.961-966
  16. Epstein JI. An update of the Gleason grading system. J Urol. 2010;183(2):433–440.

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Last updated: 2019-07-11 20:12