StudentShare
Contact Us
Sign In / Sign Up for FREE
Search
Go to advanced search...
Free

Clinical Examination of Prostate Cancer - Case Study Example

Cite this document
Summary
The paper "Clinical Examination of Prostate Cancer" discusses that surgical treatment for prostate cancer includes: pelvic lymphadenectomy, radical prostatectomy, and transurethral resection of the prostate.   The other treatment modalities used are radiation therapy and hormone therapy…
Download full paper File format: .doc, available for editing
GRAB THE BEST PAPER91% of users find it useful
Clinical Examination of Prostate Cancer
Read Text Preview

Extract of sample "Clinical Examination of Prostate Cancer"

 A 67 years old male complained of severe back pain of one week duration and increased frequency of urination and pain while urinating, of 2 weeks duration. Family history: his father is deceased, and had prostate cancer. Investigations: biopsy showed a well differentiated prostate adenocarcinoma. Computerized tomography showed an increased size of the prostate. There is a heterogeneous density and a small hypodense area, correspond to interior necrosis. Examination: blood pressure- 120/80; CVS: Clear S1, S2; Abdomen: Soft, nontender, nondistended, nontender, bowel sounds present; Back: Limited range of movement; Rectal exam: the sphincter tone is decreased, no blood. The prostate is enlarged and hard to palpation. Clinical diagnosis Whenever a prostate cancer is suspected, the clinical examination and tests may include: urine analysis for the presence of any blood or infection, a digital rectal examination, and blood test to measure the level of prostate-specific antigen (PSA). At times, especially when the results of the PSA are suspicious, the level of prostatic acid phosphatase (PAP) may also have to be checked (UCSF Medical Center 2007.) Anatomy From: Malecare. http://www.malecare.com/prostate-cancer_42.htm The prostate is an exocrine gland of the male reproductive system, which stores and secretes a slightly alkaline fluid, milky white in appearance. The gland is placed immediately below the internal urethral orifice and around the beginning of the urethra. The apex of the prostate is situated at the urogenital diaphragm while the base is situated at the bladder neck. The prostate is comprised of various zones, the peripheral zone, the central zone, and the transition zone. The central zone is a cone-shaped area, wherein the apex of the cone is at the meeting points of the ejaculatory ducts and the prostatic urethra at the verumontanum (Hammerich et al n.d.). The peripheral zone includes all prostatic tissue at the apex along with the tissue located posteriorly near the capsule. The transition zone includes prostatic tissue lateral to the urethra in the middle of the gland (Hammerich et al n.d.). The convexity of the anterior external surface is formed by the anterior fibromuscular stroma and has striated muscle at the apical half, with smooth muscle cells towards the base (Hammerich et al n.d.). The prostatic capsule is made up of fibrous tissue surrounding the gland. The seminal vesicles are located superior to the base of the prostate. Each seminal vesicle joins with the vas deferens on each side to form the ejaculatory ducts. The histology of the prostate shows it to be a branched duct gland (Hammerich et al n.d.) MRI & CT images of normal prostate and prostatic cancer MRI of normal prostate. MRSI of prostate cancer From:RadiologyInfo From: ucsf. www.ucsf.edu/multimedia/photography/details/67/ http://www.radiologyinfo.org/en/info.cfm?pg=mr_prostate CT image of normal prostate (p). CT Prostate cancer. From:Radiographics From: Radiology www. radiographics.rsnajnls.org/.../full/23/4/951/F3A www. radiology.rsnajnls.org/.../full/243/1/28/F4 Pathology Prostate cancer invading soft tissue around the prostate gland. From: BCM http://www.bcm.edu/pathology/labs/Ittmann/overview.htm After the initial transformation, prostate cancer develops due to further mutations of numerous genes (including genes for p53 and retinoblastoma). Ultimately, tumor progression and metastasis occurs (Theodorescu and Krupski 2009). The majority of prostate cancers (95%) are adenocarcinomas, while the morphology of approximately 4% of prostate cancers is of the transitional cell type (arising from the urothelial lining of the prostatic urethra). About 1 % has a neuroendocrine morphology, arising from the neuroendocrine stem cells normally present in the prostate or from aberrant differentiation (Theodorescu and Krupski 2009). Location wise, 70% of prostate cancers arise in the peripheral zone, 15-20% in the central zone, and 10-15% in the transitional zone. They can be locally invasive, and spread to the ejaculatory ducts, bladder neck and seminal vesicles. Later, they can penetrate through the prostatic capsule and along the perineural or vascular spaces. Early metastasis to the bone can occur. Distant metastases to the liver, lungs, and adrenal glands etc can also occur (Theodorescu and Krupski 2009.) Role of imaging modalities in the diagnosis Transrectal Ultrasound (TRUS)-involves the transmission of ultrasound by a probe inserted into the rectum. These waves bounce off the prostate and the echoes are received by a computer to create a sonogram (UCSF Medical Center 2007), which can be used to detect abnormal areas in the prostate or for guiding transrectal biopsy (Taneja 2004.) Color Flow Doppler/Power Doppler- theoretically, when compared to grayscale ultrasound, color flow Doppler can identify isoechoic cancers. It can also show the blood flow characteristics, which allows to distinguish malignant from benign lesions within hypoechoic areas. Power Doppler is 3 to 4 times more sensitive than color Doppler for areas of increased flow (Taneja 2004.) MRI-MRI (magnetic resonance imaging) is a procedure for obtaining a series of detailed images of the body using a magnet, radio waves, and a computer (National Cancer Institute n.d). A better visualization of the zonal anatomy of prostate, as well as the location and extent of tumor can be obtained by the use of an endorectal coil (magnetic coil placed directly into the rectum ) MRI. Magnetic Resonance Spectroscopy (MRSI) “is an MRI technique that attempts to identify cancer through the assessment of tissue metabolites” (Taneja 2004). By using a strong magnetic field, MRSI obtains metabolic information (spectra). This helps to identify the relative concentrations of various metabolites in the cell cytoplasm and the extracellular space. This technique can identify metabolic differences in prostate tissue (BPH, prostate cancer, and normal prostate tissue) (Carroll et al 2006) Imaging for the staging of prostate cancer-some imaging modalities are used in the staging of prostate cancer. An accurate staging helps to maximize treatment efficacy (Taneja 2004). Staging can be divided into local staging, in order to identify extracapsular extension, and distant staging, in order to identify metastases to lymph nodes and bone (Taneja 2004.) 1. Distant staging a. Radionuclide bone scan-involves the injection of a radioactive material in to the blood, which is then detected in the bone with a scanner (National Cancer Institute n.d). The usual isotope, which is used is Technetium 99m (99mT)-labeled diphosphonate (Taneja 2004.) b. Computerized tomography (CT)-this involves taking a series of pictures from different angles of the body, which is interpreted by a computer to produce an image. CT scan is used in prostate cancer to identify abnormally enlarged lymph nodes. In order to define larger foci of metastatic disease in the lymph nodes, a 3-D MRI reconstructed T1-weighted images can be used (Taneja 2004.) 2. Local Staging- Imaging utilized for pre-operative assessment of disease stage include: TRUS and MRI/MRSI (Taneja 2004.) Treatment 1. Surgery: a. Pelvic lymphadenectomy: this surgery involves the removal of pelvic lymph nodes, and visualization of the nodes under a microscope by the pathologist for malignant cells. If the lymph nodes are negative for malignant cells, the prostate is not removed and other treatment modalities are used (National Cancer Institute n.d) b. Radical prostatectomy: this surgery involves the removal of the prostate, surrounding tissue, and seminal vesicles. Two types of radical prostatectomy may be done: retropubic prostatectomy, in which the prostate is removed through an abdominal wall incision along with removal of adjacent lymph nodes (National Cancer Institute n.d), and perineal prostatectomy, which involves the removal of the prostate through an incision in the perineum along with removal of adjacent lymph nodes (National Cancer Institute n.d). c. Transurethral resection of the prostate (TURP): this surgery involves the removal of the prostate with a resectoscope inserted through the urethra (National Cancer Institute n.d) 2. Radiation therapy-here, high-energy x-rays are used to destroy the malignant cells. Radiation therapy is of two types: external radiation therapy and internal radiation therapy. External radiation therapy involves the use of a machine external to the body, to send radiation toward the cancer. In internal radiation therapy, needles, seeds, wires, or catheters containing a radioactive substance, is directly placed into or near the cancer (National Cancer Institute n.d). For low, intermediate, and high-risk patients, low-dose rate brachytherapy can be used. High-dose-rate brachytherapy, used alone or in combination with external-beam radiotherapy can be beneficial in patients with localized prostate cancer (Koukourakis et al 2009). 3. Hormone therapy-male sex hormones produced normally by the body can make the prostate cancer grow. Hormone therapy thus involves the use of drugs (ketoconazole, aminoglutethimide, and antiandrogens- flutamide and nilutamide), surgery (orchiectomy), or other hormones (luteinizing hormone-releasing hormone agonists-leuprolide, goserelin, estrogens) to either block the male sex hormones or reduce their production (National Cancer Institute n.d) 4. New types of treatment a. Cryosurgery-Cryosurgery or cryotherapy is the use of an instrument to freeze and destroy prostate cancer cells (National Cancer Institute n.d). Cryotherapy is a potential alternative to standard therapies for the primary treatment of localized prostate cancer (Shelley et al 2007.) b. Chemotherapy-this type of treatment uses drugs, which either kills the cancer cells or stops them from dividing, and therefore, stops the growth of cancer cells (National Cancer Institute n.d) c. Biologic therapy- also known as biotherapy or immunotherapy, involves the use of the patient’s own immune system with either substances made by the body or made in a laboratory to fight cancer (National Cancer Institute n.d) d. High-intensity focused ultrasound-this type of treatment uses ultrasound (high-energy sound waves) to destroy cancer cells. In prostate cancer, the sound waves are created by an endorectal probe (National Cancer Institute n.d) Prognosis of prostate cancer In general, the prognosis for the majority of patients with prostate cancer (localized or regional) is very good. Depending on their age and comorbidities, the life expectancy for elderly men with prostate cancer varies. A long-term local control, or even cure, is possible in many patients but depends on the staging and grade of the tumor (The Merck Manuals, 2009.) If treatment is delayed, a poor prognosis is given for patients with high-grade, poorly differentiated cancer. The response to conventional therapy is poor in undifferentiated prostate cancer, squamous cell carcinoma, and ductal transitional carcinoma. There is no cure for metastatic cancer, and the median life expectancy with metastatic disease is 1 to 3 years (The Merck Manuals, 2009.) Conclusion The clinical examination and tests for a patient with prostate cancer includes: urinalysis, digital rectal examination, and measurement of blood prostate-specific antigen (PSA) levels. The majority of prostate cancers (95%) are adenocarcinomas and about 70% of prostate cancers arise in the peripheral zone. They can be locally invasive, and early metastasis to the bone and distant metastases to the liver, lungs, and adrenal glands etc can occur. The imaging modalities employed in the diagnosis of prostate cancer includes the use of transrectal ultrasound (TRUS), color flow Doppler, power Doppler, MRI and MRSI. Some imaging modalities are used in the staging of prostate cancer, and these include: radionuclide bone scan, computerized tomography (CT), TRUS and MRI/MRSI. The surgical treatment for prostate cancer includes: pelvic lymphadenectomy, radical prostatectomy, and transurethral resection of the prostate (TURP). The other treatment modalities used are radiation therapy and hormone therapy. The newer types of treatment for prostate cancer includes: cryosurgery, chemotherapy, biologic therapy, and high-intensity focused ultrasound. In general, the prognosis for the majority of patients with prostate cancer is very good. There is no cure for metastatic cancer. References BCM. Prostate cancer and fibroblast growth factors. http://www.bcm.edu/pathology/labs/Ittmann/overview.htm Carroll, PR, Coakley, FV and J. Kurhanewicz 2006. Magnetic Resonance Imaging and Spectroscopy of Prostate Cancer. Rev Urol. 8(Suppl 1): S4–S10. Hammerich, KH, Ayala, GE and TM. Wheeler, n.d. Anatomy of the prostate gland and surgical pathology of prostate cancer. Cambridge University Press. www.cambridge.org. Koukourakis G, Kelekis N, Armonis V and V. Kouloulias. 2009. Brachytherapy for prostate cancer: a systematic review. Adv Urol. Malecare. Prostate. http://www.malecare.com/prostate-cancer_42.htm National Cancer Institute n.d. Prostate cancer treatment. http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page2. Radiology. CT prostate cancer. www. radiology.rsnajnls.org/.../full/243/1/28/F4 RadiologyInfo. MRI of prostate. http://www.radiologyinfo.org/en/info.cfm?pg=mr_prostate Radiographics. Anatomy of prostate. www. radiographics.rsnajnls.org/.../full/23/4/951/F3A Shelley M, Wilt TJ, Coles B and M.D. Mason. 2007. Cryotherapy for localised prostate cancer. Cochrane Database Syst Rev. Taneja, SS. 2004. Imaging in the Diagnosis and Management of Prostate Cancer. Rev Urol. 6(3): 101–113. Theodorescu, D and T.L. Krupski. 2009. Prostate Cancer - Biology, Diagnosis, Pathology, Staging, and Natural History. Emedicine. http://emedicine.medscape.com/article/458011-overview. The Merck Manuals. 2009. Prostate cancer. http://www.merck.com/mmpe/sec17/ch241/ch241e.html UCSF Medical Center. 2007. Prostate cancer. http://www.ucsfhealth.org/adult/medical_services/cancer/urologic/conditions/prostate/diagnosis.html. UCSF Medical Center. 2007. MRI prostate cancer. www.ucsf.edu/multimedia/photography/details/67/ Read More
Cite this document
  • APA
  • MLA
  • CHICAGO
(Clinical Examination of Prostate Cancer Case Study, n.d.)
Clinical Examination of Prostate Cancer Case Study. Retrieved from https://studentshare.org/health-sciences-medicine/1727148-prostate-cancer
(Clinical Examination of Prostate Cancer Case Study)
Clinical Examination of Prostate Cancer Case Study. https://studentshare.org/health-sciences-medicine/1727148-prostate-cancer.
“Clinical Examination of Prostate Cancer Case Study”. https://studentshare.org/health-sciences-medicine/1727148-prostate-cancer.
  • Cited: 1 times

CHECK THESE SAMPLES OF Clinical Examination of Prostate Cancer

Human Health and Diseases

Physical examination is the general examination of the human body performed by physicians.... In the world, many new diseases and conditions emerge and therefore require extensive clinical examination to avoid misinterpretations.... Components of physical examination The components of physical examination include inspection, palpation, percussion, and auscultation respectively.... Physical examination helps in confirming any persistent issues after a previous diagnosis....
6 Pages (1500 words) Essay

Electron Portal Imaging System

Introduction The treatment of cancer by the means of radiation or exposure to a radioactive element requires further research to allow for the achievement and enhancement of pivotal objectives behind radiotherapy.... (2003), the process of portal imaging aims to employ the assistance of bony landmarks to establish the placement and setup of the patient that is relative to the focal point of radiation, however, further considerations into the subject are required to direct researchers into the application and implementation of portal imaging systems in radiotherapy when discussing target volumes in soft tissue tumors of the prostate....
9 Pages (2250 words) Article

Testicular Pain

Relevant to ask in the Family History are infertilities in siblings, history of penile, prostate and testicular cancer, and hernias (Siedel, et.... ocused Scenario 2 3Physical examination should be done primarily on the patient's reproductive system.... The clinical inferences made on this patient include testicular trauma which is most probable, due to the fact that the patient rides a bike everyday and engages in physical sports....
2 Pages (500 words) Case Study

Case study about Urology

Statistical values show that having BPH does not seem to increase the possibility of prostate cancer.... Many patients hear from their friends that their symptoms may be prostate cancer and for some that drives them to see a physician but for others, it means denial and attempting not to see a physician.... This is a noncancerous proliferation of the prostate gland tissue.... prostate surgery is the second most common surgical intervention in men older than age 60....
6 Pages (1500 words) Essay

The Use of Tumour Markers

Currently, only the Prostate Specific Antigen (PSA) has been recommended and approved for general screening of prostate cancer in men over 50.... A positive screening result for PSA is still not an indication of cancer, and PSA screening should be done in conjunction with a digital rectal examination of the prostate gland for diagnostic purposes.... Tumour markers are chemicals or biological compounds that are normally produced by healthy cells, but are produced in… Additionally, when some metabolic pathway or function is affected by cancer, normal tissues could break down resulting in increased concentrations of analytes that also serve as markers for Therefore, it is important to understand that it is the quantity and not just the presence of these compounds that must be considered in assessing the clinical use of tumour markers....
4 Pages (1000 words) Essay

Care Plan Genitourinary Clinical Case

The patient has to be educated on importance of exercising and proper diet to reduce his weight and a diet without spicy food and citrus fruits as they may cause bladder irritation (prostate cancer UK,... Due to the presenting symptoms (decreased urinary flow and gradual worsening symptoms of nocturia, weak urinary stream, and dysuria with burning prostatitis) benign prostatic hyperplasia (BPH), bladder and prostate cancers have to be ruled out to get the main cause of his… The patient is referred to an urologist for further genitourinary work up, to a cardiologist for managing the grade II/VI systolic murmur, and finally the patient will be referred to a gastroenterologist due to the presence of blood in stool. The patient presents with y flow and gradual worsening symptoms of nocturia, weak urinary stream, dysuria with burning, android obesity, blood in stool and an elevated PSA level with enlarged, boggy prostate that is tender to palpation....
3 Pages (750 words) Assignment

Peptic Ulcer Disorder

Methods available to screen prostate cancer include digital rectal examination, transrectal ultrasound, prostate-specific antigen, and a combination of tests (Kaplan & McVary, 2014).... A PSA level that is greater than 10ng ml-1 indicates a higher possibility of prostatic cancer.... BPH refers to a growth of the prostate gland that is noncancerous.... The disease is common in elderly because the prostate continues to grow during a man's lifetime....
1 Pages (250 words) Essay

Hybridoma Technology

Monoclonal antibodies are being used to track cancer antigens, to attack cancer metastases, and preventing graft-versus-host disease in bone marrow transplants.... The paper "Hybridoma Technology" states that tissues and tumours can be classified based on their expression of certain markers, with the help of monoclonal antibodies....
6 Pages (1500 words) Coursework
sponsored ads
We use cookies to create the best experience for you. Keep on browsing if you are OK with that, or find out how to manage cookies.
Contact Us