Prostate cancer

Prostate cancer - Chronic

Definition  

A usually slow-growing, malignant tumor within the prostate gland

 

Post treatment monitoring of prostate cancer  

* Prostate specific antigen measurement: PSA levels should be obtained as often as 3 months, but at least every 6 months, for patients on active surveillance; every 6 to 12 months for 5 years, then every year, following a radical prostatectomy or radiation therapy; and every 3 to 6 months for patients with regional lymph node or distant metastases .

 

Medical History  

* Aging

* Excessive dietary intake of fat

* Family history of Prostate cancer

* Genetic predisposition

* Environmental Exposure

 

Findings  

* Prostate nodule

* Dysfunctional voiding of urine

* Hematuria

* Lymphedema - Chronic

* Bone pain

 

Tests  

Suspected prostate cancer  

* Prostate specific antigen measurement: There is no PSA value below which a man can be certain that he does not have prostate cancer ; proceeding to biopsy should be based primarily on PSA and digital rectal exam with consideration of other pertinent factors .

 

Suspected prostate cancer in patients with an abnormal digital rectal exam or a PSA that is above normal for age  

* Biopsy of prostate: A prostate biopsy is necessary to make a definitive diagnosis of prostate cancer, to assess Gleason score for staging of the cancer, and to guide clinical decision-making .

 

Pretreatment staging of patients with biopsy-proven prostate cancer  

* Prostate specific antigen measurement: A risk stratification scheme based on PSA levels, biopsy Gleason scores, and clinical T stages that are associated with the risk of PSA failure and prostate cancer-specific mortality following radical prostatectomy, external beam radiotherapy, or interstitial prostate brachytherapy may be used to guide treatment .

 

Men with newly diagnosed prostate cancer and a Gleason score of 8 or greater or stage T3 or greater disease, even if the PSA level is less than 10 ng/mL  

* Radioisotope scan of bone

 

Differential Diagnosis  

* Benign prostatic hyperplasia - Chronic

* Prostatitis - Acute

 

Treatment  

 

Drug Therapy  

 

Medical castration as a first-line hormonal therapy option for men with metastatic prostate cancer and as a treatment option for men with locally advanced prostate cancer  

 

LEUPROLIDE ACETATE

 

GOSERELIN ACETATE

 

Antiandrogen therapy in combination with LHRH agonist therapy for men with overt metastases who are at risk of developing symptoms with the flare in testosterone associated with initial LHRH agonist therapy  

 

BICALUTAMIDE

 

FLUTAMIDE  

 

NILUTAMIDE

 

Procedural Therapy  

 

Localized prostate cancer  

* Active surveillance: Active surveillance is a treatment option for men with low-risk localized cancers regardless of life expectancy and for men with intermediate-risk localized cancers and a life expectancy of less than 10 years .

 

Localized prostate cancer  

* Radical prostatectomy: Radical prostatectomy provides a potential cure for men with truly localized prostate cancer and is a reasonable option for men with a life expectancy of 10 years or more .

 

Localized or locally advanced prostate cancer  

* External beam radiotherapy, Entire prostate: External beam radiotherapy is indicated as a curative treatment for clinically localized prostate cancer in men who do not have a history of inflammatory bowel disease or a history of prior pelvic radiotherapy. Dose escalation or adjuvant hormonal therapy may be indicated .

 

Localized prostate cancer  

* Intracavitary brachytherapy, Entire prostate: Ideal candidates for brachytherapy are men without very large or small prostates, who do not have symptoms of bladder outlet obstruction, and have not had a previous transurethral resection of the prostate .

 

Locally advanced or metastatic prostate cancer  

* Orchiectomy: Surgical castration by orchiectomy and medical castration using LHRH agonist therapy are equally effective. Androgen deprivation therapy should begin immediately for patients with tumor-related symptoms or overt metastases .