Prostate Cancer and Associated Conditions

Flashcards covering the definition, epidemiology, risk factors, pathophysiology, clinical presentation, diagnosis, screening, staging, treatment, and complications of prostate cancer, benign prostatic hyperplasia (BPH), and prostatitis based on lecture notes.

Prostate Cancer Epidemiology

The most common malignant neoplasm in men in the United States (excluding skin cancer) and the second leading cause of cancer death in men of all races and Hispanic origin populations.

Prostate Cancer Risk Factors

Advancing age, African-American race, positive family history of prostate cancer, and geography (more common in Caribbean men of African ancestry, North America, northwestern Europe, and Australia).

Most Common Type of Prostate Cancer

Adenocarcinoma.

Gleason System

A histologic grading system used as an important predictor of prognosis for malignant neoplasms in prostate cancer.

Common Sites of Prostate Cancer Metastasis

Lymph nodes and bone.

Early Prostate Cancer Symptoms

Urinary hesitancy, urgency, nocturia, frequency, and hematuria (often asymptomatic in early stages).

Advanced Prostate Cancer Symptoms

Back pain, impotence, bone pain (suggesting metastasis), weight loss, constipation, malaise, hematuria, rectal pain, or nerve root compression symptoms (paresthesias, extremity weakness).

Prostate-Specific Antigen (PSA) Normal Level

Below 4 ng/mL, although a tumor may still be present. Values 4-10 ng/mL may indicate early prostate cancer or benign conditions; >10 ng/mL suggests prostate cancer.

PSA Velocity Indicative of Prostate Cancer

A rate of rise of more than 0.75 ng/mL per year (though recent trials suggest it adds little predictive information to total PSA).

Transrectal Ultrasound (TRUS) with Biopsy

Recommended for men older than 60 years with PSA >4.0 ng/mL or abnormal DRE findings, to guide biopsy of suspicious hypoechoic areas.

Radionuclide Bone Scan Indication in Prostate Cancer

Positive biopsy with PSA >10 ng/mL or Gleason score >7, to determine bone metastases.

Elevated Alkaline Phosphatase in Prostate Cancer

Suggests bone metastasis.

Elevated Acid Phosphatase in Prostate Cancer

Suggests prostatic metastasis.

Differential Diagnosis for Prostate Cancer Symptoms

Benign Prostatic Hyperplasia (BPH) and prostatitis, bladder cancer, urinary tract infection, and urethral stricture.

Digital Rectal Examination (DRE) Findings Suggestive of Prostate Cancer

A firm nodule, induration, or a stony, asymmetric prostate on rectal examination.

Prostate Cancer Screening Controversy

Controversy exists regarding initial PSA screening and interval testing, with different organizations (AUA, ACS, USPSTF) offering varied recommendations based on age and individual risk.

Goals of Prostate Cancer Treatment

Based on the stage at diagnosis, prognostic features of the tumor, and the patient’s age, medical condition, and treatment preference.

AJCC TNM System

The most widely used staging system for prostate cancer, describing the extent of the primary tumor (T), spread to nearby lymph nodes (N), and presence of distant metastases (M).

Treatment Options for Localized Prostate Cancer (T1 and T2)

Active surveillance, radiation therapy (brachytherapy or external beam), and surgery.

Androgen Deprivation Therapy (ADT)

Used for symptomatic patients with advanced prostate cancer or for those who do not want surgery, with mixed evidence on long-term outcomes.

Hormone Treatments for Prostate Cancer

Oral estrogens, orchiectomy, luteinizing hormone–releasing hormone (LHRH) agonists, antiandrogens, and progestational agents.

Major Complication of Prostate Cancer

Metastatic disease.

Complications of Radical Prostatectomy

Hemorrhage, injury to obturator nerve, ureter, or rectum, incontinence, and impotence.

Complications of Radiation Therapy for Prostate Cancer

Urinary problems (cystitis, hematuria, frequency, dysuria, urethral stricture), intestinal sequelae (diarrhea, fecal incontinence, rectal bleeding, obstruction), impotence, and transient edema.

Complications of Cryotherapy for Prostate Cancer

Urethral stricture, irritative symptoms, urinary incontinence, impotence, rectourethral fistula, bladder neck contracture, and urinary retention.

Signs of Advanced Prostate Cancer

Bone pain, hematospermia, macroscopic hematuria, and renal failure.

Spinal Cord Compression from Prostate Tumor Metastasis

Acute neurologic symptoms such as weakness, numbness, urinary retention, urinary incontinence, or fecal incontinence. This is an emergency requiring early intervention.

Benign Prostatic Hyperplasia (BPH) Definition

A noncancerous enlargement of the prostate gland, an almost ubiquitous phenomenon among older men.

Prevalence of BPH

50% to 70% among men 50 years and older, and up to 80% among men 70 years and older.

Pathophysiology of BPH

Related to a complex interaction between androgen and estrogen secretion; abnormal serum elevations stimulate prostatic growth. Dihydrotestosterone (DHT) is the main mediator.

Obstructive Symptoms of BPH

Urinary hesitancy, decreased caliber and force of the stream, and postvoid dribbling, related to bladder outlet obstruction (BOO).

Irritative Symptoms of BPH

Frequency, urgency, and nocturia, resulting from decreased functional bladder capacity and instability or infection.

Male Lower Urinary Tract Symptoms (MLUTS)

Term expanded to include symptoms related to bladder storage and/or voiding disturbances in men.

DRE Findings for BPH

The prostate typically feels rubbery with no palpable nodules on DRE, but may have uniform or focal enlargement.

AUA Symptom Index for BPH

Used to quantify BPH symptoms and aid in classifying severity and developing a treatment plan.

Alpha1-Adrenergic Antagonist Therapy for BPH

Relaxes smooth muscle in the bladder neck, prostate capsule, and prostatic urethra to improve urinary flow.

5α-Reductase Inhibitor Therapy for BPH

Shrinks prostatic glandular hyperplasia by decreasing tissue DHT levels (e.g., dutasteride and finasteride).

Complications of BPH

Urinary tract infection and urinary retention, which can lead to renal problems if not detected early.

Prostatitis Definition

Inflammation of the prostate gland, a common problem in adult males classified into acute bacterial, chronic bacterial, chronic nonbacterial/chronic pelvic pain syndrome (CNP/CPPS), and asymptomatic prostatitis.

Acute Bacterial Prostatitis Symptoms

Fever, chills, malaise, myalgias, arthralgias, urinary hesitancy, frequency, urgency, nocturia, dysuria, sensation of incomplete bladder emptying, low back pain, perineal pain, or suprapubic pain.

DRE Findings for Acute Bacterial Prostatitis

The prostate is typically enlarged, with tenderness and induration.

Organisms Causing Acute Bacterial Prostatitis

Usually gram-negative organisms (E. coli, Proteus species, Klebsiella, Enterobacter, Serratia, Pseudomonas aeruginosa); also some gram-positive cocci (Staphylococcus aureus, streptococci, enterococci).

Organisms Causing Chronic Bacterial Prostatitis

Gram-negative and gram-positive bacteria, including Chlamydia trachomatis, Enterococci species, Klebsiella pneumonia, Proteus mirabilis, Enterobacter cloacae, Staphylococcus aureus, Trichomonas vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Serratia marcescens, and Pseudomonas aeruginosa.

First-Line Antibiotics for Acute Bacterial Prostatitis

Fluoroquinolones (levofloxacin or ciprofloxacin) or trimethoprim-sulfamethoxazole (TMP/SMX) for 2 to 4 weeks.

Treatment of Chronic Bacterial Prostatitis

More complex due to difficulty in achieving therapeutic intraprostatic antibiotic levels; fluoroquinolones are agents of choice, often combined with alpha-blockers. Longer courses of antibiotics (7-12 weeks) may be needed.