Prostate Cancer Describe the Pathophysiology

Prostate Cancer

Describe the pathophysiology of prostate cancer- What is occurring in the body?

The pathophysiology of prostate cancer is poorly understood because of the lack of a reliable animal model of prostate cancer (Dreicer). However, according to Dreicer, many believe that high-grade prostatic intraepithelial neoplasia (PIN) is the most likely precursor of invasive prostate cancer. PIN is characterized by cellular proliferation within preexisting ducts and glands, with cytologic changes that mimic those of cancer (Bostwick, 1995) PIN is associated with progressive abnormalities of phenotype and genotype that are intermediate between normal prostatic epithelium and cancer (Bostwick, 1995).

Most prostate cancers start in the peripheral zone, but they can also begin in the central or the transitional zone (Pathophysiology of prostate cancer). However, according to this same source, the cancer may also be multi-focal, appearing at different regions of the prostate at the same time. Adenocarcinomas is the most common cell morphology, but cells can have also have neuroendocrine cell morphology (Pathophysiology of prostate cancer). The source explains that the progression of the cancer is still not known in most cases, but that once the process of cancer sets in, it spreads from one region to another, and as the cancer progresses, it spreads to the bladder neck, ejaculatory duct and the seminal vesicles.

What signs and symptoms would you observe from a patient who has prostate cancer?

In prostate cancer's earliest stages, most men will not experience any symptoms, but some men, may experience (Prostate cancer symptoms):

A need to urinate frequently, especially at night;

Difficulty starting urination or holding back urine;

Weak or interrupted flow of urine;

Painful or burning urination;

Difficulty in having an erection;

Painful ejaculation;

Blood in urine or semen; or Frequent pain or stiffness in the lower back, hips, or upper thighs.

In later states of the disease, prostate cancer cells that spread to the bone, also known as prostate cancer bone metastases, can begin to interfere with the normal health and strength of the bones, often leading to bone pain, fracture, or other complications that can significantly impair health (Managing bone metastases and pain).

What studies are available to confirm the diagnosis of prostate cancer?

The prostate-specific antigen (PSA) blood test and the digital rectal exam (DRE) are used together to screen for prostate cancer (PSA and DRE screening) as this source explains in the following way. The prostate produces the Still, the DRE and PSA tests cannot diagnose prostate cancer, but they can signal the need for a biopsy to examine the prostate cells for cancer as described next (Diagnosis (Gleason scores and staging the disease)). During a biopsy, needles are inserted into the prostate to take small samples of tissue, often under the guidance of ultrasound imaging. After examining the cells under a microscope, the pathologist looking at the biopsy uses the Gleason grading system for prostate cancer to assign one Gleason grade to the most common pattern, and a second Gleason grade to the next most common pattern. The two grades are then added to obtain the Gleason score. The Gleason grading scale ranges from 1 to 5, where 1 represents cells that are very nearly normal, and 5 represents cancerous cells. After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.

What medicines, treatments, and/or surgeries are used for a patient who has prostate cancer?

Treatment options depend on: the stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other places in the body); the patient's age and health and whether the cancer has just been diagnosed or has recurred (General information about prostate cancer). There are three main treatment options.

For tumors that are still inside the prostate, a surgery called radical prostatectomy and radiation therapy are common treatment options (Prostate cancer treatment options). This source describes these two options. Radical prostatectomy removes the whole prostate gland and the nearby lymph nodes. There are 2 types of radiation therapy, external beam radiation therapy and seed therapy also called brachytherapy. In external beam radiation therapy, radiation is given from a machine like an x-ray machine and in brachytheraphy, radioactive pellets (called "seeds") are injected into the prostate gland. Both types have similar results in curing prostate cancer, but involve different side effects and time commitments from the patient.

"Watchful waiting" and hormones are also treatment options (Prostate cancer treatment options). With "watchful waiting," treatment is not given until the tumor gets bigger. This may be the best option for an older man who has a higher risk of dying from something other than prostate cancer. Most tumors that have grown beyond the edge of the prostate can't be cured with either radiation or surgery. In this case, hormones are used to slow the cancer's growth.