Updated: 12/27/2021

Prostate Cancer

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
4
0
0
0%
0%
Evidence
6
0
0
Topic
Images
https://upload.medbullets.com/topic/120455/images/pca.jpg
  • Snapshot
    • A 58-year-old man presents to his primary care physician for an annual examination. He does not have any acute complaints and feels otherwise healthy. He has a past medical history of hypertension that is adequately controlled with lisinopril. Family history is remarkable for prostate cancer in his father. Digital rectal examination is notable for an asymmetric, nodular prostate. Prostate-specific antigen level is elevated at 15 ng/mL.
  • Introduction
    • Overview
      • malignancy arising from the prostate
        • most prostate cancers are adenocarcinomas
          • arises most commonly in the posterior lobe (peripheral zone)
  • Epidemiology
    • Incidence
      • most common cancer in men
      • more common in older men (> 65 years of age)
    • Risk factors
      • increasing age
      • family history
      • black race
  • Presentation
    • Symptoms
      • asymptomatic in most cases
      • lower urinary tract symptoms
        • e.g., urinary retention
    • Physical exam
      • digital rectal exam (DRE)
        • prostate nodules, induration, or asymmetry
  • Studies
    • Serum labs
      • prostate-specific antigen (PSA)
        • not specific for malignancy (e.g., can be elevated in benign prostatic hyperplasia)
    • Invasive studies
      • biopsy
        • indication
          • confirms the diagnosis and important for pathologic staging
            • provides a Gleason grade
  • Differential
    • Benign prostate hyperplasia
      • differentiating factors
        • symmetric enlargment and firmness of the prostate
  • Treatment
    • Treatment dependent on pathological features, metastasis, and the patient's life expectancy
      • e.g., if patient is already on maintenance GnRH therapy, external beam radiation therapy is used to treat symptomatic metastasis
  • Complications
    • Obstructive uropathy
    • Metastatic spinal cord compression
      • prostate cancer can metastasize to the spine, causing epidural spinal cord compression
        • if metastatic spinal cord compression is suspected or confirmed in a patient with neurologic deficits, initial management includes administration of high-dose steroids to reduce edema and inflammation
        • in patients with suspected spinal cord compression but no neurologic deficits, steroid therapy may not be necessary
        • if neoplastic spinal cord compression is suspected, work-up includes:
          • MRI is first-line imaging modality
          • CT myelography is second-line imaging modality, for patients with contraindications to MRI
Flashcards (0)
Cards
1 of 0
Questions (4)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M3.ON.12.3) A 51-year-old man presents to the emergency department with an episode of syncope. He was at a local farmer's market when he fainted while picking produce. He rapidly returned to his baseline mental status and did not hit his head. The patient has a past medical history of diabetes and hypertension but is not currently taking any medications. His temperature is 97.5°F (36.4°C), blood pressure is 173/101 mmHg, pulse is 82/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for clear breath sounds and a S4 heart sound. Rectal exam reveals a firm and nodular prostate that is non-tender and a fecal-occult sample that is negative for blood. Which of the following is this patient's presentation most concerning for?

QID: 102735

Benign prostatic hyperplasia

9%

(1/11)

Normal physical exam

0%

(0/11)

Prostate abscess

0%

(0/11)

Prostate cancer

64%

(7/11)

Prostatitis

18%

(2/11)

M 10 E

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M3.ON.12.1) A 97-year-old man visits the urology clinic 5 days after experiencing urinary retention at an emergency department visit. The patient has a history of hypertension, type II diabetes mellitus, stroke, dyslipidemia, a past myocardial infarction, and severe osteoarthritis in his right hip. He is not compliant with his medications and his multiple comorbidities are poorly managed. In the hospital, the patient’s urinary retention was treated with Foley catheterization. At clinic, the patient’s serum-specific prostate-specific antigen (PSA) is 6.0 ng/mL (normal is < 4 ng/mL). Digital rectal examination (DRE) demonstrates a nontender prostate with several rock hard nodules. The patient's Foley is removed and he is able to urinate on his own. Which is the most appropriate next step in management?

QID: 103024

CT abdomen and pelvis

0%

(0/7)

Cystourethroscopy

0%

(0/7)

Transrectal prostate biopsy

86%

(6/7)

Reassurance

14%

(1/7)

Repeat PSA test

0%

(0/7)

M 10 E

Select Answer to see Preferred Response

Evidence (6)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (5)
Private Note