Internal Medicine

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

1224 Prostate Cancer

Prostate Biopsy

■6–12 core needle biopsies of the prostate usually necessary

Other Imaging Studies

■Radionuclide bone scan if PSA >10 or poorly differentiated cancer

■Transrectal MRI may confirm extension beyond the prostate

differential diagnosis

■Elevated serum PSA may be due to BPH, prostate infection, or

recent urinary tract procedures such as catheterization, endoscopy,

or biopsy.

■Lower urinary tract symptoms may be due to BPH, UTI, neurogenic

bladder disease, bladder cancer or urolithiasis.

management

What to Do First

■Treat spinal cord compression and obstructive uropathy if present.

General Measures

■Estimate extent of disease by digital rectal examination, tumor grade

(Gleason score), and serum PSA.

■Consider other staging studies (bone scan, CT scan).

specific therapy

Indications

■Localized (organ-confined) disease in a patient with at least a 10-year

life expectancy

■Metastatic bone disease

■Symptomatic, locally advanced

Treatment Options for Organ-Confined Cancer

■Radical prostatectomy, external beam radiotherapy, interstitial

radiotherapy (brachytherapy or “seeds”), watchful waiting

■Surgery offers the highest probability of cancer-free survival, but

radiotherapy results are comparable for small, well to moderately

differentiated tumors.

■Major risks of surgery: significant incontinence 2–10%; erectile dys-

function 10–50% (age and tumor dependent, usually treatable)

■Major risks of radiation: rectal and bladder irritation, uncertain inci-

dence of erectile dysfunction, urinary retention