Prostate cancer
Alternative names:
cancer of the prostate
Symptoms:
The symptoms and signs of prostate cancer depend on how advanced
the cancer is when it is diagnosed.
- No symptoms (often the case in earlier stages)- cancer
is usually detected in this situation by either digital
rectal exam (DRE), Prostate Specific Antigen (PSA) blood
test, or is discovered incidentally during a transurethral
prostatectomy (TURP).
- urinary hesitancy
(delayed or slowed start of urinary stream)
- urinary dribbling, especially immediately after urinating
- urinary retention
- pain with urination
- pain with ejaculation
- lower back pain
- pain with bowel movement
Additional symptoms that may be associated with this disease:
Signs and tests:
A physical examination
(rectal exam) typically reveals hard, irregular surface of
an enlarged prostate.
- Hard, irregular surface of an enlarged prostate, a palpable
lump, or hardened seminal vesicles on rectal exam
- Hard, palpable, pelvic lymph glands (if the cancer spread)
· Bone tenderness in areas of metastasis
- Decreased lower extremity strength, altered lower extremity
weakness, decreased anal sphincter tone, altered lower extremity
sensation (all of these signs are suggestive of spinal cord
compression)
The tests that are performed in the evaluation of prostate
cancer perform three functions: (1) detection - to determine
the existence of the cancer, (2) staging - to determine the
extent of the cancer and (3) further studies - to evaluate
for complicating features of the disease. Commonly Performed
Tests:
- PSA (prostate specific
antigen) greater than
4 nanograms/milliliter (ng/ml); benign
prostatic hypertrophy (BPH)
may be the cause of levels between 4 to 10 ng/ml. The degree
of PSA elevation aids in determining the prognosis. Prostate
Acid Phosphatase is a test that was performed routinely
in the past, and is also elevated in prostate cancer. However,
it is not performed as commonly now, as it is less specific
than the PSA.
- A Transrectal Ultrasound (TRUS) examination can reveal
an enlarged prostate or a nodule.
- Urine or prostatic fluid cytology
reveal atypical cells
- A prostate biopsy
confirms the diagnosis (can be TRUS guided) of Prostate
cancer. Pathology almost always reveals an adenocarcinoma.
Histologic grading (Gleason's score) provides prognostic
information. The higher the Gleason's score, the more aggressive
the cancer is and the more likely it is to metastasize.
- A bone scan may be
performed to rule out metastasis.
- Chest xray may be performed to rule out metastasis.
- Urinalysis may reveal
blood or pus in the urine.
Other tests that may be performed:
- Urine or prostatic fluid cytology can reveal atypical
cells
- IVP may be performed
to rule out metastasis
(spread of the cancer).
- A magnetic resonance imaging study (MRI) can rule out
spinal cord compression. Endorectal (through the rectum)
MRI coil can be performed to assure that the disease is
localized to the prostate prior to initiating therapy.
Staging:
Prostate cancers are classified or staged based on their
aggressiveness and the degree that they are different from
the surrounding prostate tissue (differentiation). There are
several different ways to stage tumors. The classic "Whitmore-Jewett"
system uses the A-B-C-D staging system. This staging system
also contains several substages, but it basically categorizes
tumors using the following scale:
- A - tumor not palpable (able to be felt) but detectable
in microscopic biopsy
- B - palpable tumor confined to prostate
- C - extension of tumor beyond prostate with no distant
metastasis
- D - cancer has spread to regional lymph nodes
In 1997, the American Joint Committee on Cancer (AJCC) and
the International Union Against Cancer adopted a revised TNM
(Primary Tumor, Nodal status, Metastasis) staging system with
a conventional I-IV staging system that essentially corresponds
to the A-D staging system.
Updated Date: 05/08/00
Updated by: Bradley G. Somer, MD, Division
of Hematology-Oncology, Hospital University of Pennsylvania,
Verimed Health Network
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