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Carcinoma of the Prostate

Prostate Cancer

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.


Presentation

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]
  • A man in his late 70s, on hormonal treatment for prostatic adenocarcinoma, presented with bilateral enlarged and painful testes.[ncbi.nlm.nih.gov]
  • We describe a case of such metastasis which, unlike previous reports, presents as a painful epididymal mass.[ncbi.nlm.nih.gov]
  • The tumor was painful and had invaded the mandible. Fine-needle aspiration of the mass and immunohistochemical staining for prostate-specific antigen confirmed the diagnosis. The patient died 1 month later of an unrelated cause.[ncbi.nlm.nih.gov]
  • […] burning urination Difficulty in having an erection A decrease in the amount of fluid ejaculated Painful ejaculation Blood in the urine or semen Pressure or pain in the rectum Pain or stiffness in the lower back, hips, pelvis, or thighs Remember: urinary[pcf.org]
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]
  • 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]
  • In the advanced stage, complaints may occur such as bladder voiding disorders, bone pain and later weight loss and anemia. Usually the patient complains also only then about increasing back pain or symptoms similar to those of prostatic hyperplasia.[hyperthermia-centre-hannover.com]
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]
  • 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]
  • 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 See Presentation for more detail.[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]
Lymphadenopathy
  • 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]
  • Assess for: asymmetry/extension into the neurovascular bundles obliteration of the rectoprostatic angle involvement of the urethra extension into the seminal vesicles (normal seminal vesicles have high signal on T2) Lymphadenopathy is best appreciated[radiopaedia.org]
  • The cancer spreads to bone early, often without significant lymphadenopathy. Currently, 2 predominant theories have been proposed for spread: the mechanical theory and the seed-and-soil theory.[emedicine.medscape.com]
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]
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]
Bone Pain
  • 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]
  • In the advanced stage, complaints may occur such as bladder voiding disorders, bone pain and later weight loss and anemia. Usually the patient complains also only then about increasing back pain or symptoms similar to those of prostatic hyperplasia.[hyperthermia-centre-hannover.com]
  • […] night difficulty commencing and maintaining urination blood in the urine painful urination and, less commonly, ejaculation difficulty achieving or maintaining an erection may be difficult Advanced prostate cancer can involve the following symptoms: bone[medicalnewstoday.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]
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]
  • Author information 1 Department of Urology, Gazi Universiry, Faculty of Medicine, Ankara, Turkey. mozgurtan@yahoo.com Abstract A 65-year-old man presented with a history of painless gross hematuria and severe obstructive symptoms.[ncbi.nlm.nih.gov]
  • 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]
  • Ductal carcinoma of the prostate is a rare variant of prostate cancer that presents most commonly with obstructive urinary symptoms or hematuria.[ncbi.nlm.nih.gov]
  • In all 5 patients, there were obstructive symptoms and elevated prostate-specific antigen; one patient had also hematuria. Their ages ranged from 69 to 82 years (mean age, 76 years).[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]
  • 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]
  • Men who don’t have surgery also avoid many of the common side effects, like urinary incontinence and erectile dysfunction.[health.harvard.edu]
  • 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.[healthengine.com.au]
Enlargement of the Prostate
  • Digital rectal examination and ultrasonography (USG) showed an enlarged hard nodular prostate. Serum prostate-specific antigen (PSA) and prostatic acid phosphate levels were found to be within the normal range.[ncbi.nlm.nih.gov]
  • 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]
Urinary Retention
  • 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]
  • A 68-year old man consulted with a two-year history of increasing urinary outflow obstruction that developed into acute urinary retention. A routine suprapubic prostatectomy was carried out, following which normal voiding was achieved.[ncbi.nlm.nih.gov]
  • One patient presented with lower urinary tract symptoms with a hard nodular prostate on digital rectal examination, and the other with acute urinary retention on normal digital rectal examination.[ncbi.nlm.nih.gov]
  • CASE REPORT: We analyzed three cases of prostatic BCC and all of them complained of acute urinary retention and digital rectal examination disclosed a stony hard prostate. However, all of them presented with low prostate-specific antigen.[ncbi.nlm.nih.gov]
  • This patient presented with lower urinary tract symptoms with acute urinary retention after TURP.[ncbi.nlm.nih.gov]
Dysuria
  • 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]
  • Urgency and dysuria may signify a urinary tract infection, not uncommon in older males.[symptoma.com]
  • Abstract A 58-year-old man presented with dysuria at the Osaka Medical College Hospital in November 1996. Laboratory examination revealed elevated serum prostate-specific antigen (PSA) to 100 ng/mL.[ncbi.nlm.nih.gov]
  • Case Presentation A 57-year-old male presented to the emergency department with complaints of dysuria, a decreased urinary stream, and hesitancy for 2–3 months associated with fever and chills.[karger.com]
  • Due to the location of the tumor, predominant symptoms are gross hematuria and dysuria, and digital examination often reveals negative findings. PSA is not necessarily elevated [ 2 ].[karger.com]

Workup

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]
  • Morphologic recognition and distinction from other prostatic lesions and tumors with prominent lymphoid stroma is critical for its clinical management.[ncbi.nlm.nih.gov]
  • Results: In this investigation a mean SUV max of 1.88 0.44 in healthy prostate tissue compared with 10.77 8.45 in malignant prostate lesions ( P 0.001) was observed.[ncbi.nlm.nih.gov]

Treatment

  • Using Kaplan-Meier curves and Cox regression analyses, we assessed the effect of treatment and clinical stage on overall survival.[ncbi.nlm.nih.gov]
  • Because this clinical condition is extremely rare, a gold standard treatment has yet to be established.[ncbi.nlm.nih.gov]
  • BACKGROUND: The effects of age on clinical presentation, treatment, and outcomes for patients with small-cell carcinoma of the prostate (SCCP) are unclear.[ncbi.nlm.nih.gov]
  • He died 5 months from the start of treatment. The autopsy revealed small cell carcinoma of the prostate and multiple metastasis of the lung, liver, pancreas, lymph nodes and spine.[ncbi.nlm.nih.gov]
  • GI symptom scores and parameters of anorectal function and anal sphincter morphology did not differ between the 2 RT schedules or treatment techniques.[ncbi.nlm.nih.gov]

Prognosis

  • UCP patients with prostatic stromal invasion showed a significantly worse prognosis than those without stromal invasion (P 0.0108).[ncbi.nlm.nih.gov]
  • Most patients present late with high GS carcinoma and therefore have poor prognosis.[ncbi.nlm.nih.gov]
  • They have very poor prognosis.[ncbi.nlm.nih.gov]
  • Primary signet-ring cell carcinoma (SRCC) of the prostate is very rare and has a poor prognosis, even when treated with aggressive therapy. We report herein a case of a 72-year-old man with prostatic SRCC.[ncbi.nlm.nih.gov]
  • Primary basal cell carcinoma of the prostate is a very rare neoplasm with a good prognosis. A 55-year-old man presented with urinary frequency for 2 months. Serum prostate-specific antigen level was normal.[ncbi.nlm.nih.gov]

Etiology

  • Their etiology is uncertain and may represent a single malignant process or a mixture of two distinct malignancies.[ncbi.nlm.nih.gov]
  • Since effective treatment of a prostatic tumor, or part of a tumor, with an SCC etiology differs from that of pure adenocarcinoma, early recognition of any histologic or clinical changes in the patient with prostate cancer may alter the course of the[ncbi.nlm.nih.gov]
  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • 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

  • On univariate analyses, age CONCLUSIONS: Using the SEER database, we present the largest study describing the epidemiology of primary SCC of the prostate.[ncbi.nlm.nih.gov]
  • MATERIALS AND METHODS: This is a retrospective study of RP during 2004 to 2013 using Surveillance, Epidemiology, and End Results to compare IDC-P with non-IDC-P.[ncbi.nlm.nih.gov]
  • METHODS: A retrospective review was performed on 259 patients who were identified with SCCP in the national Surveillance, Epidemiology, and End Results (SEER) registry from January 1973 to December 2004.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To use the national Surveillance, Epidemiology, and End Results (SEER) cancer registry to describe the natural history, national incidence and treatment patterns for ductal prostate cancer (PCa) over the last 20 years, as the available literature[ncbi.nlm.nih.gov]
  • "[Descriptive epidemiology of prostate cancer in Japan and Western countries]". Nippon Rinsho (in Japanese). 63 (2): 207–12. PMID 15714967. Jaubert de Beaujeu M, Chavrier Y (January 1976).[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • PURPOSE: To characterize the prevalence, pathophysiology, and natural history of chronic radiation proctitis 5 years following radiation therapy (RT) for localized carcinoma of the prostate.[ncbi.nlm.nih.gov]
  • 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

  • A bilateral nephrostomy was performed to improve renal function, and an ileostomy was established to prevent ileus. The first induction chemotherapy consisted of amrubicin 35 mg/m(2) (days 1, 2, 3, monthly).[ncbi.nlm.nih.gov]
  • BACKGROUND: Small-cell carcinoma of the prostate is an aggressive cancer whose rarity has prevented the development of a consensus management approach.[ncbi.nlm.nih.gov]
  • […] pathway may be able to help prevent suppression of cancer-fighting T cells OX40: activating this co-stimulatory pathway can help promote T cell survival after activation PD-1/PD-L1: blocking this pathway can help prevent cancer-fighting T cells from[cancerresearch.org]
  • Bottom line: men shouldn’t take selenium or vitamin E as a way to prevent prostate cancer, or anything else for that matter.[health.harvard.edu]
  • Causes, Risk Factors, and Prevention Learn about the risk factors for prostate cancer, what you might be able to do to help lower your risk, and early detection of the disease.[cancer.org]

References

Article

  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.

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Last updated: 2019-07-11 20:28