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  • 185 Malignant neoplasm of prostate
  • 233.4 Carcinoma in situ of prostate

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  • C61 Malignant neoplasm of prostate
  • D07.5 Carcinoma in situ of prostate

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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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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 dysfunction
  • Lumbar spine radiculopathy
  • Prostatic cysts
  • Prostatic tuberculosis
  • Prostatitis

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Laboratory Tests

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  • PSA Screen
  • Reverse transcription-polymerase chain reaction (RT-PCR)

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Imaging

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