Affected men may present with symptoms of benign prostatic hyperplasia (BPH). If surgery is performed, carcinoma of the prostate may be incidentally found. Also, it can be diagnosed based on prostate-specific antigen (PSA) abnormal values or anomalous digital rectal examination findings in asymptomatic patients. Smokers seem to have a higher chance to develop the condition [1]. In addition, in this population group, the disease seems to be more aggressive at the time of the diagnosis [2]. The illness has a prolonged clinical course and most patients diagnosed with carcinoma of the prostate will ultimately die of other reasons [3]. When the disease is not clinically silent, patients complain about a weak urine stream, hesitancy, incontinence, hematuria, back pain or urine retention. Urgency and dysuria may signify

The illness has a prolonged clinical course and most patients diagnosed with carcinoma of the prostate will ultimately die because of other reasons [3]. When the disease is not clinically silent, patients complain about a weak urine stream, hesitancy, incontinence, hematuria, back pain, or urine retention. Urgency and dysuria may signify a urinary tract infection, not uncommon in older males. In the locally invasive stage, the illness causes incontinence, nocturia, hematuria, hematospermia, painful ejaculation, suprapubic and perineal pain, impotence, rectal tenesmus, and sometimes anuria or other manifestations of acute or chronic kidney disease. Advanced and metastatic disease presents with inappetence and weight loss or with clinical manifestations related to bone metastases (pain and pathological fractures), spinal cord compression (paraplegia), vascular obstruction (lymphedema, pain in the lower extremities, deep vein thrombosis), ureteral obstruction (uremia), as well as sciatica and lethargy (caused by uremia or anemia).

Clinical examination should be thoroughly performed and may reveal cachexia, adenopathy, or an overdistended bladder. Digital rectal examination is considered to be unreliable in differentiating benign and malignant prostate diseases. This examination is also useful in determining the tonus of the external anal sphincter, which is diminished if spinal cord compression exists. The method may raise tumor suspicion if changes are detected over time and if a nodule, asymmetry, or heterogeneous textures of different areas are found. The gland may be adherent to the neighboring structures and the seminal vesicles may be palpable. When the diagnosis of carcinoma of the prostate is confirmed, the patient must be informed about the available treatment modalities and their impact on the quality of life [4].

• Pain

  In the locally invasive stage, the illness causes incontinence, nocturia, hematuria, hematospermia, painful ejaculation, suprapubic and perineal pain, impotence, rectal tenesmus, and sometimes anuria or other manifestations of acute or chronic kidney [symptoma.com]

  At this point, what had been called retro-orbital pain was determined to be more consistent with a neuropathic burning pain along the CN VI distribution on the right side. [touchoncology.com]

  Often, the syndrome is marked by an insidious course during which patients present with generalised bony pain and weakness, which do not resolve until the underlying tumour is identified and treated. [casereports.bmj.com]

  A man in his late 70s, on hormonal treatment for prostatic adenocarcinoma, presented with bilateral enlarged and painful testes. [ncbi.nlm.nih.gov]

• Weight Loss

  […] effect, but with lower weight loss. [ncbi.nlm.nih.gov]

  Advanced and metastatic disease presents with inappetence and weight loss or with clinical manifestations related to bone metastases (pain and pathological fractures), spinal cord compression (paraplegia), vascular obstruction (lymphedema, pain in the [symptoma.com]

  If the cancer has spread beyond the prostate gland, men may experience swelling in the lower body, back or hip pain, abnormal bowel habits or unexplained weight loss. [moffitt.org]

  loss, anemia, hematuria, renal failure, generalized body weakness, and fecal incontinence. 3 The average male in the United States should begin considering the possibility of prostate cancer at age 50 years. [retinatoday.com]

  Symptoms of advanced prostate cancer may include unexplained weight loss, feeling the frequent or sudden need to urinate, or pain in the lower back/pelvic area or sciatica. [cancersa.org.au]

• Lymphadenopathy

  We describe a case of 64-year old man who clinically presented with inguinal lymphadenopathy. Because of elevated PSA levels biopsy of prostate was done and adenocarcinoma was diagnosed. [pagepressjournals.org]

  Pulmonary metastasis and generalized lymphadenopathy commonly develop after pelvic and bone involvement have already occurred. [casesjournal.biomedcentral.com]

  Butler et al. were among the first researchers who studied supraclavicular lymphadenopathy as the initial presentation of previously unrecognized prostate cancer. 18 of the 19 cases they reported had left supraclavicular lymphadenopathy as the initial [omicsonline.org]

  Advanced carcinoma of the prostate presenting initially with supraclavicular lymphadenopathy is uncommon. These are 2 cases of advanced prostate cancer that presented initially with persistent painless left supraclavicular mass. [ncbi.nlm.nih.gov]

• Lymphedema

  Advanced and metastatic disease presents with inappetence and weight loss or with clinical manifestations related to bone metastases (pain and pathological fractures), spinal cord compression (paraplegia), vascular obstruction (lymphedema, pain in the [symptoma.com]

  Lifestyles Physical Activity Nutrition and Weight Management Supplement Use Immunizations and Infections Late Effects/Long-Term Psychosocial and Physical Problems Anthracycline-Induced Cardiac Toxicity Anxiety and Depression Cognitive Function Fatigue Lymphedema [nccn.org]

  Lymphedema Lymphedema, a condition of localized fluid retention and tissue swelling, can result from damage to the lymphatic system sustained during radiation therapy. [en.wikipedia.org]

  Findings in patients with advanced disease may include the following: Cancer cachexia Bony tenderness Lower-extremity lymphedema or deep venous thrombosis Adenopathy Overdistended bladder due to outlet obstruction Neurologic examination, including determination [emedicine.medscape.com]

• Perineal Pain

  In the locally invasive stage, the illness causes incontinence, nocturia, hematuria, hematospermia, painful ejaculation, suprapubic and perineal pain, impotence, rectal tenesmus, and sometimes anuria or other manifestations of acute or chronic kidney [symptoma.com]

  Because of extensive rapid growth, nearly half of the patients develop urinary and fecal obstruction.[ 18 ] and severe pelvic or perineal pain due to involvement/compression of pelvic nerves. [ncbi.nlm.nih.gov]

  Seventeen months after surgery, he developed perineal pain. CT and MRI confirmed local recurrence in the prostate bed with metastases to the ischium and pubis, and his PSA was now 10.806 ng/ml. [karger.com]

  The edema and slight enlargement of the prostate with acute inflammation may cause acute rectal, lower back, or perineal pain along with fever. There can be dysuria. The prostate is enlarged and tender. [webpath.med.utah.edu]

• Loss of Appetite

  Manifestations of metastatic and advanced prostate cancer may include the following: Weight loss and loss of appetite Bone pain, with or without pathologic fracture Neurologic deficits from spinal cord compression Lower extremity pain and edema due to [emedicine.medscape.com]

  Symptoms of prostate cancer can be: Dull pain in the lower pelvic area Frequent urinating Trouble urinating, pain, burning, or weak urine flow Blood in the urine (Hematuria) Painful ejaculation Pain in the lower back, hips or upper thighs Loss of appetite [urologyhealth.org]

• Tenesmus

  A 74-year-old male came to our clinic for rectal tenesmus, lower urinary tract symptoms and a previous episode of acute retention of urine. [ncbi.nlm.nih.gov]

  In the locally invasive stage, the illness causes incontinence, nocturia, hematuria, hematospermia, painful ejaculation, suprapubic and perineal pain, impotence, rectal tenesmus, and sometimes anuria or other manifestations of acute or chronic kidney [symptoma.com]

  Painful spasms (bladder tenesmus) or a burning sensation while urinating. Spasms or pain and discomfort centered in the pelvic area or groin. Or, any unexplained swelling in the lower extremities. [roboticoncology.com]

  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]

• 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]

• Cyanosis

  Extremities were without clubbing, cyanosis, or edema, and skin exam was unremarkable. [oatext.com]

• Bone Pain

  pain, weakness, and fractures. [casereports.bmj.com]

  Difficulty in passing urine, bone pain, weight loss and tiredness are common symptoms. Please visit our Information Links page for more information. [prostate.org.nz]

  Significant urinary or constitutional symptoms or bone pain were denied at initial presentation. Patient was referred to head and neck surgeons for assessment of lower neck mass. [omicsonline.org]

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

  In June 2014, the patient was admitted to hospital with generalized weakness, dehydration, and diffuse bone pain. [current-oncology.com]

• Lethargy

  […] manifestations related to bone metastases (pain and pathological fractures), spinal cord compression (paraplegia), vascular obstruction (lymphedema, pain in the lower extremities, deep vein thrombosis), ureteral obstruction (uremia), as well as sciatica and lethargy [symptoma.com]

  Lethargy (anaemia, uraemia). Weight loss, cachexia. Signs Advanced disease: general malaise, bone pain, anorexia, weight loss, obstructive nephropathy, paralysis due to cord compression. [patient.info]

• Hematuria

  When the disease is not clinically silent, patients complain about a weak urine stream, hesitancy, incontinence, hematuria, back pain or urine retention. [symptoma.com]

  Here, we describe an unusual case of hematuria and primary fibriolysis as the presenting manifestation of metastatic prostate cancer in a 52-year-old man. The patient consulted for hematuria, ecchymosis and bleeding gums for a month. [ashpublications.org]

  Herein, we report a new case of primary signet ring cell carcinoma of the prostate in an 85-year-old man with voiding disorder and hematuria. Based on this case, we present the anatomopathologic, clinical, and therapeutic aspects of this rare entity. [ncbi.nlm.nih.gov]

• Urinary Incontinence

  The most common side effects are erectile dysfunction (loss of erections) and urinary incontinence (leaking urine). It is important to talk with your doctor to understand potential side effects of each treatment option available to you. [zerocancer.org]

  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]

  Men who don’t have surgery also avoid many of the common side effects, like urinary incontinence and erectile dysfunction. [health.harvard.edu]

  It not only has the advantages of less pain and faster recovery time as is the case with laparoscopic surgery, but it also increases the chances of patients being able to control urinary incontinence post-surgery and minimizes the risks of erectile dysfunction [bumrungrad.com]

• Enlargement of the Prostate

  Urological review revealed enlarged hard nodular prostate and transrectal prostate biopsy findings in keeping with high grade adenocarcinoma in both cases. [ncbi.nlm.nih.gov]

  Enlarge Normal prostate and benign prostatic hyperplasia (BPH). A normal prostate does not block the flow of urine from the bladder. An enlarged prostate presses on the bladder and urethra and blocks the flow of urine. [cancer.gov]

  However, PSA levels can be affected by the non-cancerous enlargement of the prostate that many men experience as they age – as well as certain medications – so false positives and false negatives from testing are not uncommon. [giantmicrobes.com]

• Urinary Retention

  This patient presented with lower urinary tract symptoms with acute urinary retention after TURP. [ncbi.nlm.nih.gov]

• Dysuria

  Urgency and dysuria may signify a urinary tract infection, not uncommon in older males. [symptoma.com]

  A 53-year-old man presented to our department with acute urinary retention and an approximate 8-year history of frequent urination, dysuria, poor urinary stream and nocturia. His prostate-specific antigen (PSA) values were normal ( 2014 S. [ncbi.nlm.nih.gov]

  […] cancer cases in men and 9% of deaths due to cancer in men.2 Statistics for 2009 estimated 192,280 new cases and 27,360 deaths related to prostate cancer. 2 Clinical symptoms of prostate cancer include lower urinary tract obstruction, urination frequency, dysuria [retinatoday.com]

  Initially he reported expected side effects including mild pain, dysuria, and increased urinary frequency. He was instructed to maintain a high level of fl uid intake and completed a 7-day course of antibiotic therapy. [cancernetwork.com]

Carcinoma of the prostate screening is currently made using digital rectal examination and PSA. The first method is examiner-dependent but able to indicate the need for further evaluation. Transrectal ultrasonography often yields false positive results but is a useful tool in guiding biopsies.

Blood workup offers limited information in incipient stages, but kidney and liver function tests are mandatory in patients with advanced disease. Urinalysis signals the presence of infection in some cases. A computed tomography scan is indicated in cases where metastases are suspected. The final diagnose is made by needle biopsy, but several biopsies are needed in order to diminish the risk of false negative results. Furthermore, the histological assessment must be corroborated with the prostate specific antigen value. Prognosis is determined using the Gleason score.

No prostate-specific antigen value can guarantee that prostate cancer is absent. However, the higher the value of this parameter is, the higher the probability of neoplasia. Prostate-specific antigen velocity is another parameter that can be used if clinical judgment dictates [5].

In cases where osseous metastases are suspected, bone scintigraphy with technetium-99m offers relevant information, while recurrences seem to be best observed if 11C-choline positron-emission tomography is used [6].

Screening for carcinoma of the prostate is controversial because of the unpredictable clinical course of the disease. Most cases show a low progression rate. A method that identifies what group the patient belongs to has yet to be identified. Some argue that at this time screening does not seem to reduce the 10-year mortality [7], while others found a 20% reduction in fatal cases of prostate cancer if screening is performed [8].

• Prostatic Lesion

  IDC-P has to be distinguished from several other prostate lesions with similar histological appearance. [ncbi.nlm.nih.gov]

  On CT, 66% to 90% of bony prostatic lesions are osteoblastic, characterized by hyperostotic bone with irregular, often spiculated, new bone involving a surrounding soft tissue mass. [healio.com]

  Shohreh ID: Premalignant and malignant prostate lesions: pathologic review. Cancer Control. 2010, 17 (4): 214-222. 3. [jmedicalcasereports.biomedcentral.com]

1. Zu K, Giovannucci E. Smoking and aggressive prostate cancer: a review of the epidemiologic evidence. Cancer Causes Control. 2009;27;27:27.
2. Pickles T, Liu M, Berthelet E, et al. The effect of smoking on outcome following external radiation for localized prostate cancer. J Urol. 2004;171(4):1543–1546.
3. Freedland SJ, Humphreys EB, Mangold LA, et al. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA. 2005;294(4):433–439.
4. Wilt TJ, MacDonald R, Rutks I, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148(6):435–448.
5. Vickers AJ, Till C, Tangen CM, et al. An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection. J Natl Cancer Inst. 2011;103(6):462-469.
6. Eiber M, Souvatzoglou M, Maurer T, et al. Initial experience in restaging of patients with recurrent prostate cancer: comparison of 11C-choline-PET/MR and 11C-choline-PET/CT [abstract 343]. Presented at: 2013 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI); June 11, 2013; Vancouver, British Columbia, Canada.
7. Andriole GL, Crawford ED, Grubb RL 3rd, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360(13):1310-1319.
8. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320-1328.