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Prostate cancer

Introduction

Usually occurs in men over 50 years and is most often asymptomatic. Systemic symptoms, i.e. weight loss, bone pain, etc. occurs in 20% of patients. Obstructive voiding symptoms and urinary retention are uncommon.

Risk factors

Signs and Symptoms

Diagnostic criteria

• The prostate gland is hard and may be nodular on digital rectal examination and/or PSA elevation
• Verification of prostate cancer is by prostate core biopsy
• As the axial skeleton is the most common site of metastases, patients may present with back pain or pathological fractures.
• Lymph node metastases can lead to lower limb lymphoedema.
• Serum prostate specific antigen (PSA) is generally elevated and may be markedly so in metastatic disease.
• Non-pharmacological treatment
• Wathful waiting- low risk patients with short life expectancy
• Active surveillance-lowest risk of cancer progression and more than 10 years life expectancy
• Radical prostatectomy- patients with localized cancer and life expectancy more than 10 years
• Surgical Androgen deprivation therapy (bilateral orchidectomy) for advanced prostate cancer

Investigation

Management

  • Pharmacological

    Medical androgen Deprivation Therapy is offered in patients with advanced disease, PSA levels more than 50 ng/ml, poorly differentiated tumour and in those who cannot receive any form of local treatment.

    Luitenising hormone releasing hormone (LHRH) Agonists

    • Inj Goserelin 3.6 mg subcutaneous every weeks or 10.8mg every 12 weeks

    OR

    • Bicalutamide (PO) 50–150mg once daily

    Castrate resistant prostate cancer

    • Docetaxel 75mg/m2 every 3 weeks

    Referral

    All patients with suspected cancer (For more detail refer to the Malignant diseases section)
  • Non-pharmacological

Prevention

Updated on,

23 Novemba 2020 12:24:35

References

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