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
- 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.
- 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
On DRE clinical signs include;
- Hard prostate gland with an irregular surface and edges
- Obliterated median sulcus
- Adherent rectal mucosa
Advanced or metastatic disease:
- |Bone tenderness
- Pathological fracture
- 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
- To relieve symptoms
- To control complications
- To achieve cure for early disease
- To prevent local progression and metastases
- 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
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:
Bicalutamide, oral, 50 mg daily (refer to specialist)
Flutamide, oral, 250 mg 8 hourly (refer to specialist)
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)
Biphosphonates and Fentanyl patches (refer to specialist)
Click the highlighted text to learn more about drugs mentioned here.
Refer all cases to a specialist centre for evaluation and management.