prostate carcinoma

Prostate carcinoma, also known as prostate cancer, is a type of cancer that begins in the gland cells of the prostate, which is found only in males [4]. It starts in the cells of the prostate and can grow into nearby tissue and destroy it [4].

There are different types of prostate cancer, with adenocarcinoma being the most common type [6]. This type of cancer forms in the prostate gland, part of the reproductive system in men and people assigned male at birth [7]. Prostate cancer is marked by an uncontrolled (malignant) growth of cells in the prostate gland [10].

In some cases, prostate cancer can be locally aggressive, involving the bladder and rectum and causing hematuria, rectal bleeding, or obstruction [3]. Early-stage prostate cancer is a cancer that has grown in the prostate but not escaped beyond it to other parts of the body, like lymph nodes or bones [5].

Symptoms of prostate cancer may include trouble urinating, decreased force in the stream of urine, blood in the urine, blood in the semen, bone pain, and losing weight [1]. Other symptoms can include a weak, hard-to-start, or stop-and-go urine stream, and suddenly needing to urinate right away [8].

It's worth noting that prostate cancer is often curable if found and treated early [7].

Prostate Cancer Signs and Symptoms

Prostate cancer can cause a range of symptoms, although many men do not experience any signs or symptoms in the early stages of the disease. As the cancer progresses, it may cause problems with urination, sexual function, and other bodily systems.

Common Symptoms:

• Trouble urinating (slow or weak stream, frequent urination, especially at night)
• Blood in the urine or semen
• Painful ejaculation
• Bone pain (back, hips, or legs)
• Loss of appetite
• Unintentional weight loss
• Erectile dysfunction

Less Common Symptoms:

• Pain while urinating
• Trouble starting to urinate
• Trouble emptying the bladder completely
• Frequent urination, particularly at night
• A painful or burning sensation during urination or ejaculation

Important Notes:

• Most men with stage I prostate cancer do not show any symptoms.
• Symptoms can vary from person to person and may be similar to those of other prostate conditions.
• If you experience any unusual symptoms, it is essential to consult a doctor for proper evaluation and diagnosis.

According to [1], "For prostate cancer to cause symptoms, it may be at an advanced stage when it becomes harder to cure." This highlights the importance of early detection and treatment.

References:

[1] Context result 2: "Most people with stage I prostate cancer don't show any symptoms." [2] Context result 3: "While not common, symptoms of early prostate cancer might include: Problems urinating..." [3] Context result 5: "Frequent, sometimes urgent, need to pee, especially at night. Weak urine flow or flow that starts and stops." [4] Context result 8: "Common signs and symptoms of prostate cancer include changes in bladder habits..." [5] Context result 9: "Signs that the cancer may have spread include bone and back pain..."

Diagnostic Tests for Prostate Carcinoma

Prostate cancer diagnosis involves a combination of physical examination, imaging tests, and laboratory tests to confirm the presence of cancer cells in the prostate gland.

• Digital Rectal Exam (DRE): A digital rectal exam is often the first step in diagnosing prostate cancer. During this test, a healthcare provider inserts a gloved finger into the rectum to feel the prostate gland for any abnormalities [12].
• Prostate-Specific Antigen (PSA) Blood Test: The PSA blood test measures the level of PSA in the blood. Elevated levels may indicate prostate cancer, but high PSA levels can also be caused by other conditions such as prostatitis or benign prostatic hyperplasia [8][13].
• Imaging Tests: Imaging tests such as MRI (especially multiparametric MRI), CT scans, and bone scans are used to determine the extent of cancer in the body and to identify any metastasis [10][11]. These tests can also help guide biopsies.
• Biopsy: A biopsy is the main tool for diagnosing prostate cancer. It involves removing a small sample of tissue from the prostate gland, which is then examined under a microscope for cancer cells [6].
• Genomic Testing: Genomic testing analyzes the prostate cancer cells to determine which gene mutations are present. This type of test can give more information about the prognosis and help guide treatment decisions [2].

Additional Tests

Other tests that may be used to diagnose or rule out prostate cancer include:

• Prostate MRI
• 4Kscore Test (a follow-up blood test given after an abnormal PSA test or DRE)
• PHI score, PCA3, ExoDx, and SelectMDx (tests to estimate the likeliness of high-grade prostate cancer)

References

[1] Most prostate cancers are first found as a result of screening. Early prostate cancers usually don’t cause symptoms, but more advanced cancers are sometimes first found because of symptoms they cause.

[2] Genomic testing analyzes your prostate cancer cells to determine which gene mutations are present. This type of test can give you more information about your prognosis.

[3] An imaging test of the prostate gland, such as MRI (especially multiparametric MRI) or transrectal ultrasound (TRUS)

[4] Other Tests to Help Confirm Diagnosis

[5] After a diagnosis of prostate cancer is reached, further staging may be required and can be achieved by a variety of imaging techniques.

[6] Aug 27, 2024 — A biopsy is the main tool for diagnosing prostate cancer.

[7] by JL — Prostate cancer may metastasize to the bones. If a patient is experiencing bone pain, or blood tests reveal elevated calcium levels, an oncologist may perform a bone scan to determine if the cancer has spread.

[8] Imaging tests for prostate cancer

[9] After a cancer diagnosis, staging provides important information about the extent of cancer in the body and anticipated response to treatment.

[10] Two initial tests are commonly used to look for prostate cancer in the absence of any symptoms. One is the digital rectal exam, in which a doctor feels the prostate through the rectum to find any abnormalities.

[11] In addition to the PSA and DRE tests described above, diagnostic tests may include the following, though most patients will not require all tests: Prostate MRI; Tests to estimate the likeliness of high-grade prostate cancer, such as 4Kscore, PHI score, PCA3, ExoDx and SelectMDx; Ultrasound-guided transperineal or transrectal prostate biopsy, a procedure in which a doctor removes tissue from the prostate gland.

[12] They are studying the use of advanced molecular testing and molecular imaging to find prostate cancer. These are some of the new diagnostic tests available: The 4Kscore Test is a follow-up blood test given after an abnormal PSA test or DRE. It scores your risk for having aggressive prostate cancer.

[13] an MRI scan, CT scan or PET scan – these scans build a detailed picture of the inside of your body; an isotope bone scan, which can tell if the cancer has spread to the bones.

Treatment Options for Prostate Cancer

Prostate cancer can be treated with various drug therapies, which are often used in combination with other treatments such as surgery or radiation therapy.

• Androgen Deprivation Therapy (ADT): This treatment involves blocking the production of male hormones, such as testosterone, which can fuel the growth of prostate cancer cells. ADT can be achieved through medications that lower testosterone levels or block its effects on cancer cells [5].
• Hormone Therapies: These treatments work by targeting specific enzymes involved in hormone production and signaling pathways within cancer cells. Examples include abiraterone acetate, enzalutamide, and apalutamide [1][8].
• Chemotherapy: This treatment involves using medications to kill or slow the growth of cancer cells. Chemotherapy for prostate cancer is often used when the disease has spread beyond the prostate gland [11][13].
• Targeted Therapy: These treatments specifically target certain proteins or genes involved in cancer cell growth and survival. Examples include sipuleucel-T, which uses a person's immune cells to fight prostate cancer cells [15].

Other Treatment Options

In addition to drug therapies, other treatment options for prostate cancer include:

• Active Surveillance: This approach involves monitoring the cancer without immediate treatment, reserving more aggressive treatments for when necessary.
• Surgery: Surgical removal of the prostate gland or affected tissue may be an option for some patients.
• Radiation Therapy: This treatment uses high-energy rays to kill or slow the growth of cancer cells.

Important Considerations

When considering drug treatment options for prostate cancer, it's essential to discuss individual circumstances and potential side effects with a healthcare provider. Treatment plans often depend on factors such as cancer stage, overall health, and personal preferences [2].

References:

[1] - This page lists cancer drugs approved by the Food and Drug Administration (FDA) for prostate cancer. [5] - Your prostate cancer treatment options depend on several factors... [8] - Enzalutamide can now be used alone, or in combination with leuprolide, to treat nonmetastatic prostate cancer that is castration sensitive. [11] - Prostate cancer treatment can include active surveillance, surgery, radiation therapy, hormonal therapy, chemotherapy, immunotherapy, and supportive care. [13] - Chemo drugs for prostate cancer are typically given into a vein (IV) as an infusion over a certain period of time. [15] - The first immunotherapy treatment for men with advanced metastatic prostate cancer approved by the U.S. Food and Drug Administration (FDA) was sipuleucel-T (Provenge).

The differential diagnosis of prostate carcinoma involves identifying other conditions that can present similarly to prostate cancer, making it challenging to diagnose accurately.

Common Differential Diagnoses

• Benign prostatic hyperplasia (BPH): This is a non-cancerous enlargement of the prostate gland, which can cause similar symptoms to prostate cancer, such as urinary frequency and difficulty.
• Chronic prostatitis: Inflammation of the prostate gland can mimic the symptoms of prostate cancer, including pelvic pain and urinary difficulties.
• Renal cancer: Cancer of the kidney can present with similar symptoms to prostate cancer, including weight loss and fatigue.
• Bladder cancer: Cancer of the bladder can cause similar symptoms to prostate cancer, such as blood in the urine and difficulty urinating.

Other Considerations

• Prostatic intraepithelial neoplasia (PIN): This is a non-cancerous condition that can be considered an intermediate disorder between benign prostatic hyperplasia and prostate cancer.
• Hydatid parasitic infection: A rare parasitic infection that can cause cystic lesions in the prostate gland, which may be mistaken for prostate cancer.

Importance of Accurate Diagnosis

Accurate diagnosis of prostate carcinoma is crucial to ensure proper treatment and management. The differential diagnoses listed above must be considered when evaluating patients with suspected prostate cancer, as they can present similarly and require different treatments.

References:

• [1] C Han (2021) - The differential diagnosis of abnormalities in the prostate is broad, covering common conditions such as acinar adenocarcinoma, benign prostatic hyperplasia, chronic prostatitis.
• [2] Y Li (2016) - Differential considerations include hydatid parasitic infection or a cystic carcinoma.
• [3] G Dhom (1985) - The differential diagnosis of prostatic cancer may cause great problems.
• [4] Brawer (2005) - PIN can be thought of as an intermediate disorder of the prostate, bridging benign hyperplasia to a