Prostatic Cancer Disease

DESCRIPTION
The prostate is composed of acinar glands and their ducts arranged in a radial fashion with the stroma containing blood vessels, lymphatics and nerves. 95% of prostate cancers are acinar adenocarcinomas.
  • Tumor grading:
    • A1, A2 & B1, B2 - confined within capsule
    • C1 - extension beyond the capsule
    • C2 - involving the seminal vesicles
    • D1 - metastatic disease in regional lymph nodes
    • D2 - metastatic disease in bone or other organs
  • System(s) affected: Reproductive
  • Genetics: Unknown
  • Incidence/Prevalence in USA: 69 per 100,000
  • Predominant age: Sixth or seventh decade
  • Predominant sex: Male only
SIGNS AND SYMPTOMS
  • May be asymptomatic early or late in the course of disease
  • Induration of the prostate on digital rectal exam
  • Hard prostate, localized or diffuse
  • Bladder outlet symptoms
  • Acute urinary retention
  • Hematuria (rare)
  • Urinary tract infection (usually unrelated)
  • Bone pain
  • Weight loss
  • Anemia
  • Shortness of breath
  • Lymphedema
  • Neurologic symptoms
  • Lymphadenopathy
CAUSES

Unknown

RISK FACTORS
  • Genetic predisposition (risk of prostatic cancer increases if a malignancy has occurred in a first degree relative)
  • Endogenous hormonal influences
  • Exposure to chemical carcinogens
  • Sexually transmitted diseases
  • Male over 60 years of age
  • Increased risk with vasectomy has been newly proposed but is unsupported
LABORATORY
  • Prostate specific antigen (PSA), elevated
  • Free PSA - low in cancer (Catalana, et al: JAMA 1995;274:1213-1220)
  • Alkaline phosphatase, elevated with metastasis
  • Urine cytology, rarely helpful

Drugs that may alter lab results: None
Disorders that may alter lab results:

  • Rectal manipulation will not significantly increase PSA
  • Prior liver or bone disease
PATHOLOGICAL FINDINGS
  • Size and shape of prostatic acini almost always altered
  • Small closely packed interposed stroma
  • Eosinophilic crystalloids present
  • Architecture disrupted
  • Cells invade perineural space
SPECIAL TESTS
  • Prostate specific antigen (PSA)
  • Free PSA
IMAGING
  • Bone scan, positive with metastasis
  • Skeletal survey, positive with metastasis
  • Lymph node aspiration, positive with metastasis
  • Computerized tomography of pelvic lymph nodes, positive with metastasis
  • Prostatic ultrasound
  • Lymphoscintigraphy
  • Magnetic resonance imaging of little value
DIAGNOSTIC PROCEDURES
  • Biopsy, fine needle aspiration or core
  • Ultrasound
  • Bone marrow aspiration
  • Bone biopsy
  • Lymph node aspiration
  • Lymph node biopsy
  • Lymphoscopic lymph node dissection
APPROPRIATE HEALTH CARE

Inpatient for surgery, outpatient for other treatment

GENERAL MEASURES
  • Therapy by tumor grade
    • A1, A2 or age > 70: Observation may be appropriate or palliative as needed
    • B1, B2: Prostatectomy, radiotherapy (external beam or brachytherapy with implants)
    • C1: Prostatectomy for selected patients, radiotherapy
    • C2, D1, D2: Hormonal (androgen) ablation, chemotherapy, radiotherapy, palliative therapy
SURGICAL MEASURES
  • Under age 70, aggressive surgery for cure
  • Surgical for stages A-B and selected C under age 70
  • Orchiectomy (reduces serum testosterone by 90%)
ACTIVITY

Full activity

DIET

No special diet

PATIENT EDUCATION

Printed material available from:

  • American Cancer Society
  • National Kidney & Urologic Diseases Information Clearinghouse, Box NKUDIC, Bethesda, MD 20893, (301)468-6345
PREVENTION/AVOIDANCE

None

POSSIBLE COMPLICATIONS
  • Cardiac failure
  • Phlebitis
  • Pathologic fracture
EXPECTED COURSE AND PROGNOSIS
  • Early diagnosis and treatment of lesions should be curable
  • Advanced disease favorable prognosis if endocrine sensitive
  • Advanced unresponsive disease progresses in 18 months average

Prostate Cancer Survival with Treatment* (Lancet 1995)

                --- Treatment ---

TimeCastrationCAB
40 months58%56%
5 years**23%26%

* Includes patients with advanced disease
** projected survival, no statistical difference
Prostate Cancer Survival without Treatment
(Denmark 1979-1983: Natural history of Prostate Cancer)*

Time% of patients surviving**
1 year80%
5 years38%
10 years17%

* Includes all patients; both early and advanced disease
** 62% of patients died primarily of prostate cancer (38% died from other causes)

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

PSA = Prostate specific antigen

Clinical Investigations
  • Cardiology
  • Dermatology
  • General Destistry
  • Cardiology
  • Dermatology

ROLE OF HOMOEOPATHY

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