Internal Medicine

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

Prostate Cancer Prostatitis 1225

Treatment Options for Locally Advanced Cancer

■Watchful waiting (followed by delayed hormonal therapy), hormonal

therapy, hormonal therapy plus external beam radiotherapy

■Surgery not indicated

Treatment Options for Metastatic Cancer

■Hormonal Therapy:

➣Androgen deprivation: bilateral orchiectomy or injection of

GnRH (LHRH) agonists (leads to depressed levels of LH and FSH)

➣Oral androgen receptor (AR) antagonists indicated during initial

therapy of symptomatic bone disease with GnRH agonists

➣The average patient has evidence of disease progression after 3–5

years of androgen deprivation.

➣Side effects: loss of sexual function, osteoporosis, loss of muscle

mass, hot flashes, hepatic dysfunction (AR antagonists)

■Emergency Treatment of Spinal Cord Compression:

➣Rapid lowering of serum testosterone if not already achieved:

ketaconazole or orchiectomy

➣Decadron plus spot radiation or (rarely) surgical laminectomy

■Therapy for Androgen-Independent Cancer:

➣Chemotherapy: Taxol and taxane-based therapies, in combina-

tion with estramustine or alkalating agents

➣Spot radiation therapy to painful bone lesions

follow-up

■Serum PSA and digital rectal examination q 3–6 months in patients

following potentially curative therapy for localized disease

■Patients with advanced disease should have a periodic bone scan,

hemoglobin and assessment of renal function.

complications and prognosis

n/a

PROSTATITIS

GARY SINCLAIR, MD

history & physical

Acute Prostatitis

■Chills, back and perineal pain, urinary frequency, malaise, myalgias,

lightheadedness