Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

Prostate Cancer 1223

➣Lymphedema (from pelvic and retroperitoneal lymph node

involvement)

➣Severe anemia secondary to bone marrow replacement

➣Symptoms of renal failure from ureteral obstruction

➣Disseminated intravascular coagulation

■Majority of men with cancer diagnosed on the basis of an ele-

vated serum prostate specific antigen (PSA) have a normal rectal

exam.

■Nodularity, induration, asymmetry of the prostate on digital rectal

examination (DRE)

■Lymphedema and spinal cord compression (paraparesis, paraplegia)

tests

Laboratory

Serum PSA:

■Prostate-specific antigen: a serine protease made by the normal

prostate (not specific for prostate cancer)

■Serum PSA is dependent on age and prostate size.

■25% of men with localized prostate cancer will have a normal PSA.

■Only 25% of men with a serum PSA 4–10 ng/ml have prostate cancer;

most have only benign prostatic hyperplasia (BPH).

■Men with known prostate cancer and a PSA <10 ng/ml rarely have

metastatic disease.

Urine:

■Early disease: normal

■Advanced disease: hematuria, especially if bladder involved

Other Tests:

■Free (unbound) and complexed serum PSA may help distinguish

cancer from BPH.

■Acid phosphatase and prostatic acid phosphastase may be elevated

in advanced disease.

■CBC, serum creatinine and alkaline phosphatase

Screening

■Annual digital rectal examination and serum PSA beginning at age

50

■Begin testing at age 40 or 45 in African Americans and men with a

family history.

■Stop annual detection when expected life expectancy <10 years.