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].
Entire Body System
- 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]
These symptoms include burning or pain during urination, loss of bladder control, painful ejaculation, and swelling in legs or pelvic area. For the test, a clinician takes a sample of your blood and sends it to a lab for analysis. [cancercenter.com]
He reports moderate pain control on his current pain regimen. He also states that his appetite is poor and that he tires easily. He is independent in his ADLs and IADLs, and even working occasionally on his good days. [palliative.stanford.edu]
SYMPTOMS The symptoms of spinal cord compression include progressive radicular pain that is aggravated by movement. This pain can be confused with the pain caused by an osteodegenerative process of the spine. [aafp.org]
- Weight Loss
[…] effect, but with lower weight loss. [ncbi.nlm.nih.gov]
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]
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]
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]
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]
- 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]
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]
Gastrointestinal
- 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]
Musculoskeletal
- Bone Pain
pain, weakness, and fractures. [casereports.bmj.com]
If you have bone pain or doctors think cancer may have spread to your bones, brain, or spinal cord, doctors will do: Bone scan Your doctors will work with you to decide which treatment is best for you. [merckmanuals.com]
STAGE D (STAGE 4) The tumour has spread to other parts of the body, most often the lymph nodes, bones, liver or lungs. Difficulty in passing urine, bone pain, weight loss and tiredness are common symptoms. [prostate.org.nz]
Prostate cancer involving the bone may cause a pathological fractures or bone pain leading to decreased functional status. [cancertherapyadvisor.com]
Neurologic
- 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]
Urogenital
- 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
In such cancers, the side effects of treatment (for example, erectile dysfunction or urinary incontinence) can be more damaging than leaving the cancer untreated. [msdmanuals.com]
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]
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]
The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be like symptoms of prostate cancer. Enlarge Normal prostate and benign prostatic hyperplasia (BPH). [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]
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]
There can be dysuria. The prostate is enlarged and tender. Urine culture may be done, but prostatic massage is contraindicated. [webpath.med.utah.edu]
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].
Ultrasound
- Prostatic Lesion
IDC-P has to be distinguished from several other prostate lesions with similar histological appearance. [ncbi.nlm.nih.gov]
Neuroimaging is important in the evaluation of these lesions. 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]
Treatment
EM is a conservative treatment strategy and involves active disease monitoring with the expectation of treatment if the cancer progresses or the patient becomes symptomatic. [cancernetwork.com]
He received hormonal androgen ablation treatment, chemotherapy, and radiation treatment. He developed androgen-independent prostate cancer; with expected death in 2-3 years. [mathewsopenaccess.com]
Hormonal treatment remains the most effective systemic treatment for metastatic prostate cancer. [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]
Prognosis Prognosis means the expected outcome of a disease. In general, the prognosis is better when prostate cancer is diagnosed while it is localised and at a lower grade. You may wish to discuss your prognosis with your specialist. [cancercouncil.com.au]
Prognosis means the expected outcome of a disease. Generally prognosis is better when prostate cancer is diagnosed at an early stage and at a lower grade. You will need to discuss your prognosis with your doctor. [cancersa.org.au]
Etiology
Their etiology is uncertain and may represent a single malignant process or a mixture of two distinct malignancies. [ncbi.nlm.nih.gov]
CSS has a multitude of etiologies. [touchoncology.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]
Our literature review shows that the etiology of squamous differentiation in prostate cancer is not well defined. [diagnosticpathology.biomedcentral.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]
Epidemiologic, pathogenetic, and clinical features of prostate carcinoma are mainly based. Also known as acinar, microacinar, or conventional adenocarcinoma. Image C Image D Other uncommon types of carcinomas in the prostate, <5%. [auanet.org]
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]
Although the exact reason for this observation is not yet clear, it is a potential topic of future research interest that can provide insight into the pathologic mechanisms and pathophysiology of this rare entity. [htct.com.br]
This pattern of spread opens the door for more research venues about the pathophysiology of the mechanisms underlying distant metastases in prostate adenocarcinoma. [casesjournal.biomedcentral.com]
It is the most common haematological abnormality observed in prostate cancer.6 DIC is considered to be the underlying pathophysiology leading to the development of NBTE. [jpma.org.pk]
Dural metastases manifesting as a subdural fluid collection and presenting as a chronic subdural hematoma is an uncommon entity with unknown pathophysiology. [surgicalneurologyint.com]
Prevention
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]
Prevention Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer, including ways to prevent it. [cancer.net]
As part of the RADAR trial, Vic also took a drug called Zometa that is commonly used for preventing osteoporosis but he stopped the medication after it flared up his gout. [hmri.org.au]
[…] 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]
Additional prevention strategies are currently being studied. What are the symptoms of prostate cancer? In most cases, prostate cancer causes no symptoms. In rare cases, men may experience certain symptoms when they have advanced prostate cancer. [uclahealth.org]
References
- Zu K, Giovannucci E. Smoking and aggressive prostate cancer: a review of the epidemiologic evidence. Cancer Causes Control. 2009;27;27:27.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.