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.

• 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]

  Our patient had involvement of the bone marrow and prostate and no systemic symptoms of fever, night sweats, or 10% weight loss in 6 months preceding admission and was thus classified as Ann Arbor stage IVA MCL. [hindawi.com]

  • Symptoms of advanced disease with weight loss, lethargy, bladder outflow obstruction, or bone pain. Clinical presentation 7. [slideshare.net]

  Paraganglioma in a 27-year-old man who presented with a history of a 10-kg (22-lb) weight loss during the preceding 4 months, an increased appetite, and the need to eat 4000 calories/day to maintain his weight. [pubs.rsna.org]

• 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

  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. [symptoma.com]

  Prostate cancer involving the bone may cause a pathological fractures or bone pain leading to decreased functional status. [cancertherapyadvisor.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]

  There are treatments for bone pain caused by bone metastases or hormone therapy. Prostate cancer that has spread to the bone and certain types of hormone therapy can weaken bones and lead to bone pain. [cancer.gov]

• Hematuria

  We describe a case of ductal adenocarcinoma of the prostate with endometrioid characteristics presenting as painless hematuria and intraurethral tumor. A 69-year-old man had intermittent painless hematuria for 2 months. [ncbi.nlm.nih.gov]

• Urinary Incontinence

  Urinary Incontinence After Prostate Cancer Treatment Urinary incontinence can sometimes result from prostate cancer treatment. Urinary incontinence is urine leakage without your control. [urologyhealth.org]

  Both urinary incontinence (not being able to hold in your urine) and impotence (inability to achieve and maintain an erection) are commonly associated with this procedure. [oncolink.org]

  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]

  incontinence fecal incontinence Treatment Treatment is different for early and advanced prostate cancers. [medicalnewstoday.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]

  […] catheterization is used to relieve the bladder in people with urinary retention. [en.wikipedia.org]

  In the pre-PSA era, patients with PC are commonly presented with lower urinary tract symptoms or urinary retention, back pain, and hematuria. Currently, with PSA screening, most PCs are diagnosed in an asymptomatic stage (2). [numonthly.com]

  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]

• 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]

  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]

  The patient first presented in 2003 at the age of 63 years with increased frequency and nocturia. He underwent TURP and 26 grams of prostate curetting examined for histopathologic abnormality. [hindawi.com]

• Dysuria

  The patients were 65, 66, and 68 years old and presented with dysuria and micturition. All patients had a medical history of a prostatic adenocarcinoma diagnosed between 5 and 7 years earlier and treated conservatively. [ncbi.nlm.nih.gov]

  There can be dysuria. The prostate is enlarged and tender. Urine culture may be done, but prostatic massage is contraindicated. [webpath.med.utah.edu]

  Nodule sensation over the penis, priapism, pain during erection, and dysuria are the most common chief complaints in patients with penile metastases due to prostate cancer (4, 8). [numonthly.com]

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.

• 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]

  High-grade prostatic intraepithelial neoplasia of the prostate: the precursor lesion of prostate cancer. International journal of clinical and experimental pathology 2, 327 (2009). [prostatecanceruk.org]

  […] ducts Prostatic Benign Lesions/Patterns Simulating Carcinoma Adenosis (atypical adenomatous hyperplasia) Basal cell hyperplasia Clear cell cribriform hyperplasia Partial atrophy Post-atrophic hyperplasia Sclerosing adenosis Other Lesions Atypical small [surgpathcriteria.stanford.edu]

  Mucin-producing tumors and tumor-like lesions involving the prostate: a comprehensive review. Adv Anat Pathol 2012;19:374–387. 3 Osunkoya AO, Nielsen ME, Epstein JI. [nature.com]

• Hypophosphatemia

  Common side effects of zoledronic acid and denosumab are fatigue, myalgias, fever, anemia, elevated serum creatinine, hypocalcemia, hypophosphatemia and osteonecrosis of the jaw. [cancertherapyadvisor.com]

• Hypophosphatemia

  Common side effects of zoledronic acid and denosumab are fatigue, myalgias, fever, anemia, elevated serum creatinine, hypocalcemia, hypophosphatemia and osteonecrosis of the jaw. [cancertherapyadvisor.com]

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]

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]

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]

The etiology of this malignant tumor is unknown. Although urethritis glandularis has been proposed to be a precursor lesion for urothelial-type adenocarcinoma, our patient did not have evidence of urethritis glandularis. [scielo.br]

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. [webpath.med.utah.edu]

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]

The platform focuses on the visualization of cancer indicators to illustrate the changing scale, epidemiological profile, and impact of the disease worldwide, using data from several key projects of IARC’s Section of Cancer Surveillance (CSU), including [gco.iarc.fr]

Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden [link.springer.com]

The impact of marriage on the overall survival of prostate cancer patients: a surveillance, epidemiology, and end results (SEER) analysis. [frontiersin.org]

Age and grade trends in prostate cancer (1974-2003): a Surveillance, Epidemiology, and End Results Registry analysis. Am J Clin Oncol. 2008; 31(4) : 375 -8 [DOI][PubMed] 8. Kotake Y, Gohji K, Suzuki T, Watsuji T, Kusaka M, Takahara K, et al. [numonthly.com]

Pathophysiology[edit] Benign prostate hyperplasia As men age, the enzymes aromatase and 5-alpha reductase increase in activity. These enzymes are responsible for converting androgen hormones into estrogen and dihydrotestosterone, respectively. [en.wikipedia.org]

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]

Atlanta: American Cancer Society, Inc. 2011. 2Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. Prostate Cancer Rates by Race and Ethnicity. Centers for Disease Control and Prevention. U.S. [cancer.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]

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]

Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group.JAMA. 1996 Dec 25;276(24):1957-63. 25. Lippman SM, Klein EA, et al. [passeportsante.net]

Prostate cancer prevention (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/prevention/prostate/healthprofessional. Accessed Feb. 20, 2017. Castle EP (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. April 12, 2017. [mayoclinic.org]

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.