Prostate Cancer Pathophysiology and Management

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Table of Contents

Differential diagnosis
Diagnostic testing
Epidemiology of prostate cancer
Expected standard of care
Patient and family education
Reference List

Differential diagnosis

Prostate cancer is associated with such symptoms as haematuria (blood in the urine), pain during urination, weakening or slowing of the urinary stream, the swelling of lymph nodes, pain in the pelvis (Murray, 2009, p 34). However, these symptoms may be caused by other diseases, in particular, benign prostatic hyperplasia (BPH), prostatitis, and adenosis. (Paner, Luthringer & Amin, 2008, p 1388). This is why physicians have to apply such a method as a differential diagnosis to make the definitive assessment of the patient. Differential diagnosis has become an inseparable part of contemporary medical practices, and it can prove to be very beneficial for oncologists or urologists.

A physician, who tries to distinguish prostate cancer from BHP, has to conduct a series of blood tests; it is necessary to focus on the level of prostate-specific antigen or kallikrein as it is also known (Korbakis, Gregorakis, Scorilas 2009, p 905). Low levels of PSA support BHP diagnosis while higher levels indicate the possibility of prostate cancer. At the moment, the use of tumour markers such as kallikrein is the most widespread method of differentiating these two disorders. One should consider is that benign prostatic hyperplasia is the most common mimicker of prostate cancer, and it is of crucial importance that physicians can distinguish these disorders.

Additionally, the symptoms of prostate cancer can be similar to that one of prostatitis, especially if we are speaking about painful sensations during urination and nocturnal urination. To confirm or rule out the prostatitis hypothesis, one has to carry out urine and blood tests: namely, one must look at the level of leukocytes in urine and the Biernacki Reaction or the rate at which erythrocytes sediment (Shoskes, 2008, p 22). High levels of leukocytes and increased rate of Biernacki reaction are characteristic of prostatitis, while normal values eliminate this hypothesis. It should be mentioned that by ruling out the possibility of prostatitis, one cannot prove that the patient has prostate cancer. In this way, a physician manages to reduce the range of diagnoses and make the final assessment more accurate.

Finally, prostate cancer can be confused with adenosis or disease of glandular tissue (Armah & Parwani, 2008, p 3). It is also accompanied by painful urination. Under the circumstance, a physician has to use immunostains such as CK903/34βE12, p63, or AMACR to determine whether the symptoms are related to adenosis or not (Armah & Parwani, 2008, p 3). Overall, at the core of differential diagnosis lies the process of elimination. As we have identified there are several mimickers of prostate cancer and it is necessary to use various methods to ascertain which prostate disorder the patient has; otherwise, there is a great likelihood that the patient will receive inappropriate treatment.

Diagnostic testing

Several tests are used specifically for patients who may have prostate cancer. One of them is prostate biopsy or removal of small tissue samples from the patient’s prostate gland. As a rule, physicians take from 6 to 18 samples from different regions of the gland (Murray, 2009, p 34). The sensitivity of this test is always disputed; according to the statistical evidence biopsy fails to detect prostate in 20 per cent of cases and at times it is necessary to conduct this test several times (Cheikh et al, 2009, p 770). The average cost of prostate biopsy is $ 2.000, yet the price may vary.

Additionally, digital rectal examination (DRE) is used for the detection of prostatic disorders. However, this test is more likely to identify an abnormality, but it will not give a definitive answer about the origins of this abnormality. As a rule, this procedure will cost the patient approximately $ 200. Among other widespread tests, we can single out the use of tumour markers, especially prostate-specific antigens such as kallikrein (Korbakis, Gregorakis, Scorilas 2009, p 905). The sensitivity of this method is 80 per cent. A patient would pay from $70 to $400 to undergo this test.

Epidemiology of prostate cancer

According to the finding of the National Cancer Institute (NCI), approximately 217,730 males are diagnosed with prostate cancer, and more than 10 percent of these cases prove to be fatal (2011, unpaged). Additionally, the statistical data indicate that the African-American population is more likely to be affected by this disease (234.6 per 100,000 men), they are followed by the white population (150.4 per 100,000 men). The occurrence of prostate cancer among Hispanic males is 125.8 per 100,000 men. the fourth place is occupied by Asian people (90.0 per 100,000 men). Finally, this disease is least widespread among Native Americans (77.7 per 100,000 men). Furthermore, one should bear in mind that the median age of the patient with prostate cancer is 67 years (National Cancer Institute, 2011, unpaged). Judging from this statistical data, one can argue that African Americans, aged above 60 are probably the most vulnerable group.

Apart from that, it is possible to argue that the occurrence of this disease in the United States has dramatically increased over the last two decades. Overall, this information is of great importance for nurses who bear major responsibility for the screening of patients. These people need to know which groups are most exposed to this risk. Early identification of prostate cancer can significantly diminish the mortality rate which is very high at the moment.

Expected standard of care

At this point, we need to speak about the so-called gold standard of patient care or the treatment mode which is supported by evidence-based research. At this point, the gold standard of care for patients is hormone therapy (Anderson, Abrahamson, Crawford, et al 2008, p 1497). This treatment mode is primarily aimed at reducing male hormones such as testosterone which stimulates the growth of cancerous cells. This method is particularly beneficial when there is a risk of metatarsal developments. Even though hormonal therapy may entail significant side-effects such as liver damage or the loss of muscle mass, both physicians and patients prefer this treatment mode over others (Anderson, Abrahamson, Crawford, et al 2008). Overall, hormonal therapy can be viewed as the first line of treatment. The key advantage of this treatment mode is that its effects are reversible, and the same thing cannot be said about radiotherapy or surgery.

The second treatment mode is surgery, in particular, prostatectomy. This option is recommended by 93 percent of urologists (Murray, 2009, p 180). On the whole, physicians’ resort to prostatectomy if hormonal therapy fails to produce any results. Surgical removal of the prostate is usually associated with such aftereffects as the importance and lack of urinary control. Besides, prostatectomy is more suitable when a tumour is localized, but not in those cases it has given rise to metastases.

It is worth mentioning that as a second-line treatment, physicians often choose radiotherapy and its survival rates are similar to those of prostatectomy (Murray, 2009, p 333). The advantage of radiotherapy is that it can be applied at different stages of cancer development. However, it can also result in colon cancer. These are the standards to which oncologists and urologists when they try to evaluate the advantages and disadvantages of different treatment options.

Patient and family education

Medical workers should never underestimate the role of patient and family education. First of all, physicians must convince patients with prostate cancer that they still have a good chance of survival and that it is not permissible for them to become despaired. The second task is to explain the advantages and disadvantages of each treatment method available to them. They need to know about hypothetical side-effects of hormonal therapy, orchiectomy, brachytherapy, etc. Additionally, medical workers must explain to patients what kind of diet they must keep increasing their chance of survival. Additionally, the physicians, as well as nurses, should encourage patients to undergo tests regularly. This argument is particularly relevant for those people who have prostatitis or BPH since they are at great risk of developing prostate cancer. It is necessary to persuade these people not to be afraid of medical examinations as they can help them avoid many health problems. This discussion shows that patient education is an important part of medical science.

Reference List

Anderson J, Abrahamsson P, Crawford D, et al (2008) Management of advanced prostate cancer: can we improve on androgen deprivation therapy? BJU International. 101, 12, 1497-1501.

Armah H. & Parwani A. (2008). Atypical adenomatous hyperplasia (adenosis) of the prostate: a case report with review of the literature. Diagnostic Pathology 3:34.

Cheikh. A. Girouin N. Colombel M. et al. (2009). Evaluation of T2-weighted and dynamic contrast-enhanced MRI in localizing prostate cancer before repeat biopsy. Springer Science & Business Media. (19) 3, pp. 770-778.

Korbakis D. Gregorakis, A. & Scorilas. A. (2009) Quantitative Analysis of Human Kallikrein 5 (KLK5) Expression in Prostate Needle Biopsies: An Independent Cancer Biomarker. Chemical Chemistry. (55), 5, pp 904-913.

Murray F. (2009). How To Prevent Prostate Problems: A Complete Guide to the Essentials of Prostate Health. Basic Health Publications, Inc.

National Cancer Institute. (2011). Surveillance Epidemiology. Prostate Cancer: Factsheet. Web.

Paner G. Luthringer D. Amin M. (2008) Best Practice in Diagnostic Immunohistochemistry. Prostate Carcinoma and Its Mimics in Needle Core Biopsies. Archives of Pathology & Laboratory Medicine (132), 9, p 1388-1396.

Shoskes. D. (2008). Chronic Prostatitis/Chronic Pelvic Pain Syndrome. NY: Humana Press.

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