Question

A 72 year old male presents to his GP for a check up after his wife’s insistence. He mentions to his doctor that he is having difficulty urinating, including needing to get up during the night to use the bathroom, and it has been gradually getting worse over time. He also mentions that his back has been sore for the last few weeks but as he has been too tired to do much, he is not sure why it is so sore. The GP takes blood for a PSA level and he also performs a DRE. The GP notes that the patient’s prostate gland is firm and irregular.

1. What is the likely diagnosis of the patient?                                                                                        (1 mark)

• The patient has been having difficulty urinating, and nocturia

Benign prostate hyperplasia

2. Describe the likely causes and how the disease progresses over time for the condition in (a)
3. What treatment would be recommended for the patient?                                                             (1 mark)

You are the nurse at the GP clinic and the GP asks you to give education on this diagnosis and what to expect, in plain language what will you tell the patient?                                                               

Answer 1

1. DRE that finds hard nodules, generalized firmness, or an unusual shape to the prostate is commonly a sign of prostate cancer.

2. Causes:-

It's not clear what causes prostate cancer.
Prostate cancer begins when some cells in prostate become abnormal. Mutations in the abnormal cells' DNA cause the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die. The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some abnormal cells can also break off and spread (metastasize) to other parts of the body.

Prostate cancer usually progresses very slowly. It can take up to 15 years for the cancer to spread from the prostate to other parts of the body (metastasis), typically the bones. In many cases, prostate cancer won't affect a man's natural life span.
About 80 percent of the time prostate cancer cells metastasize, or spread, they will spread to bones, such as the hip, spine, and pelvis bones. It can be by direct invasion or by traveling through your blood or lymphatic system. Metastatic prostate cancer is considered advanced prostate cancer.

3. Treatment:-
A. Medical procedures-

a. Particle therapy
Radiation therapy that uses a beam of particles such as protons to treat cancer.

b. Teletherapy
Radiation therapy that uses x-rays or other high-energy beams to destroy cancer cells and shrink tumours.

c. Brachytherapy
Placing radioactive material inside the body to treat cancer.

d. Radiation therapy
Treatment that uses x-rays and other high-energy rays to kill abnormal cells.

B. Surgical procedure-

a. Laparoscopic radical prostatectomy
Surgical removal of the prostate gland and surrounding tissue using several small cuts.

b. Radiosurgery
Radiation therapy that focuses high-power energy on a particular area of the body. For example, a tumour.

c. Prostatectomy
Surgical removal of all or part of the prostate gland.

d. Radical retropubic prostatectomy
Surgical removal of the prostate gland through a cut in the abdomen.

e. Laparoscopic surgery
Surgery that uses a video camera and thin tubes inserted into small cuts on the body to repair or remove tissue.

C. Medication-
The following medications relax the muscles of the bladder outlet and prostate to help relieve blockage: alfuzosin (Uroxatral) doxazosin (Cardura) silodosin (Rapaflo).

Education to patient:-

▪Choose a healthy diet full of fruits and vegetables. Avoid high-fat foods and instead focus on choosing a variety of fruits, vegetables and whole grains. Fruits and vegetables contain many vitamins and nutrients that can contribute to your health.

▪Choose healthy foods over supplements. No studies have shown that supplements play a role in reducing your risk of prostate cancer. Instead, choose foods that are rich in vitamins and minerals so that you can maintain healthy levels of vitamins in your body.

▪Exercise most days of the week. Exercise improves your overall health, helps you maintain your weight and improves your mood. There is some evidence that men who don't exercise have higher PSA levels, while men who exercise may have a lower risk of prostate cancer.

▪Maintain a healthy weight. If your current weight is healthy, work to maintain it by exercising most days of the week. If you need to lose weight, add more exercise and reduce the number of calories you eat each day. Ask your doctor for help creating a plan for healthy weight loss.

▪Talk to your doctor about increased risk of prostate cancer. Men with a high risk of prostate cancer may consider medications or other treatments to reduce their risk.