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ICD-9-CM Codes

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  • 185 Malignant neoplasm of prostate

  • 233.4 Carcinoma in situ of prostate

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ICD-10-CM Codes

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  • C61 Malignant neoplasm of prostate

  • D07.5 Carcinoma in situ of prostate

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Preferred Practice Patterns

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Key Features

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Description

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  • Cancer begins in prostate gland

  • Wraps around the urethra

  • 98% of prostatic tumors are adenocarcinomas1

  • Aggressive and slow-growing forms

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Essentials of Diagnosis

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  • Prostate Specific Antigen (PSA) screens

  • Needle biopsy

  • Gleason grade to assess risk of cancer spreading

    • The Gleason scale assigns cancer cells a score from 1 to 10, by combining the two most common patterns of cells to give a total score (i.e., 3 + 4 = grade 7)

    • These scores are broken down into three main levels

      • Gleason score of 4 or less = low-grade (well differentiated)

      • Gleason score between 4 and 7 = intermediate grade (moderately differentiated)

      • Gleason score between 8 and 10 = high-grade (poorly differentiated)

  • ABCD stages of prostate cancer

    • Stage A: Cancer found when not suspected or due to a high PSA level

    • Stage B: Cancer found due to abnormal digital rectal exam and is held in the prostate

    • Stage C: Cancer that has spread to the tissues outside of the prostate

    • Stage D: Cancer that has spread to the lymph nodes or bone

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General Considerations

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  • Prostate wraps around the urethra causing urination issues

  • Enlarged prostate does not increase risk of cancer

  • Vegetarians have a lower rate of prostate cancer

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Demographics

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  • Most frequently diagnosed visceral malignancy in American men

  • Increased risk for

    • African-American men

    • Individuals with a brother or father with prostate cancer

    • Men older than 60 years of age

  • Second most common cause of male death from cancer

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Clinical Findings

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Signs and Symptoms

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  • May be asymptomatic until late stages

  • Need to urinate frequently, especially at night

  • Difficulty urinating, slow start

  • Decreased force in the stream of urine

  • Leakage of urine after urination

  • Blood in urine

  • Blood in semen

  • Painful ejaculation

  • Swelling in legs

  • Pain or stiffness in the lower back, hips, or upper thighs

  • Sciatica

  • Bone pain (if cancer has spread)

  • Chemotherapy side effects

    • Nausea

    • Vomiting

    • Diarrhea

    • Alopecia

    • Mouth sores

    • Conjunctivitis

    • Ulcers

    • Leukopenia

    • Anemia

    • Thrombocytopenia

    • Headaches

    • Dizziness

    • Infertility

    • Peripheral neuropathies

  • Radiation side effects

    • Fatigue

    • Secondary neoplasm

    • Integumentary compromise (burns)

    • Radiation fibrosis

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Functional Implications

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  • Incontinence

  • Sexual dysfunction

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Possible Contributing Causes

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  • Androgens

  • Genetics

  • Xenotropic murine leukemia virus-related virus (XMRV)

  • Exposure to agent orange

  • Alcohol abuse

  • Exposure to cadmium

  • High animal fat diets

  • Familial history

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Differential Diagnoses

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  • Benign prostatic hyperplasia (BPH)

  • Calculi

  • Urinary tract infection (UTI)

  • Sacral ...

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