Carcinoma of the prostate is a major morbidity cause worldwide and the second most frequent cause of cancer death in men. This malignancy has a higher incidence in older individuals. Its progression is slow and most cases are identified during the asymptomatic period. However, screening for this disease is controversial.
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 . In addition, in this population group, the disease seems to be more aggressive at the time of the diagnosis . The illness has a prolonged clinical course and most patients diagnosed with carcinoma of the prostate will ultimately die of other reasons . 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 . 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 .
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 .
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 .
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 , while others found a 20% reduction in fatal cases of prostate cancer if screening is performed .