Prostate Cancer

What is Prostate cancer

Prostate cancer is any abnormal and uncontrollable prostate cells growth.
Ninety-five per cent of these tumours are adenocarcinomas. The majority of men affected are aged between 65 and 85 years.
The incidence increases with age. It is recommended that every male, 40 years and above, should have annual screening by Prostate Specific Antigen (PSA) tests and Digital Rectal Examination (DRE) since early detection is associated with better prognosis.
The benefit or otherwise of screening should be discussed with patients.
Patients with a family history of prostate cancer and should consider annual screening from 40 years and above with PSA and DRE.
It is worth noting that not every hard prostate on DRE is malignant. Likewise a normal-feeling prostate does not exclude a malignancy.
A prostatic biopsy is therefore necessary to establish a diagnosis.

Causes of Prostate Cancer

  • Ageing
  • Functional testes
  • Family history of prostate cancer, breast cancer, ovarian cancer
  • Race (more common in blacks)
  • High dietary fat intake

Symptoms of Prostate Cancer

  • Asymptomatic: prostate cancer may be present without symptoms in the early stage
  • Lower Urinary Tract Symptoms (LUTS) and International Prostate Symptom Score IPSS
  • Retention of urine.
  • Haematuria
  • General debility anorexia, weight loss, listlessness
  • Bone pain (commonly in the waist or limbs)
  • Paralysis in the lower limbs or inability to walk
  • Pathological Fracture
  • Impotence
  • Haemospermia
  • Tenesmus

Signs

On DRE clinical signs include;

  • Hard prostate gland with an irregular surface and edges
  • Obliterated median sulcus
  • Adherent rectal mucosa

Advanced or metastatic disease:

  • Anaemia
  • Uraemia
  • Wasting
  • |Bone tenderness
  • Paraplegia
  • Pathological fracture

Investigations

  • FBC
  • Blood urea, electrolytes and creatinine
  • Prostate Specific Antigen (PSA)
  • Liver function tests
  • Abdominal and pelvic ultrasound
  • Transrectal Ultrasound (TRUS) of the prostate, if available
  • Transrectal needle biopsy of the prostate
  • TRUS-guided or finger-guided

Treatment for Prostate Cancer

Treatment objectives

  • To relieve symptoms
  • To control complications
  • To achieve cure for early disease
  • To prevent local progression and metastases

Non-pharmacological treatment

  • Urethral catheterisation to relieve urinary retention where needed
  • Radical prostatectomy or radiotherapy, under specialist care, for early disease
  • Surgical castration (bilateral orchidectomy) for advanced disease

Pharmacological treatment

Evidence Rating: [A]
Pharmacological treatment of carcinoma of the prostate, which  involves hormonal manipulation, which inhibits growth of the tumour by depriving it of androgens, is best carried out under specialist care.
The common drugs used in advanced prostate cancer therapy are:

A. Antiandrogens

Bicalutamide, oral, 50 mg daily (refer to specialist)

Or

Flutamide, oral, 250 mg 8 hourly (refer to specialist)

B. Oestrogen

Stilbestrol, oral, 2-5 mg daily (Avoid in clients with cardiovascular diseases), (refer to specialist)

C. LHRH Analogues

Goserelin, SC, preferably in the abdominal wall (refer Or
Leuprolide acetate, IM, (refer to specialist)

And

Biphosphonates and Fentanyl patches (refer to specialist)
Click the highlighted text to learn more about drugs mentioned here.

Referral criteria

Refer all cases to a specialist centre for evaluation and management.