Source: Norris LB, Kolesar
JM. Prostate Cancer. In: DiPiro, JT, Talbert RL, Yee GC, Matzke
GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach.
8th ed. http://accesspharmacy.com/content.aspx?aid=8009081.
Accessed August 5, 2012.
- Malignant neoplasm that arises from prostate gland
- Hormonal, dietary, and genetic differences may contribute
to altered susceptibility in certain populations.
- Normal prostate composed of acinar secretory cells altered
when invaded by cancer.
- Adenocarcinoma found in
>95% of cases.
- Metastatic spread can occur by:
- Local extension
- Lymphatic drainage
- Hematogenous dissemination
- Skeletal metastases
most common sites of distant spread.
- Rationale for hormone therapy based on effect of androgens
on growth and differentiation of normal prostate (Figure 1).
- Testes and adrenal glands are major sources of androgens,
specifically dihydrotestosterone (DHT).
- Luteinizing hormone–releasing hormone (LH-RH) from
the hypothalamus stimulates release of luteinizing hormone (LH)
and follicle-stimulating hormone (FSH) from anterior pituitary gland.
- LH stimulates production of testosterone.
- Active, unbound testosterone penetrates prostate cell and
is converted to DHT by 5-α-reductase.
of prostate gland. (ACTH, adrenocorticotropic hormone; DHT,
dihydrotestosterone; FSH, follicle-stimulating hormone; GH, growth
hormone; LH, luteinizing hormone; LH-RH, luteinizing hormone–releasing hormone;
mRNA, messenger RNA; PROL, prolactin; R, receptor.) Reprinted with
permission from Wells BG, DiPiro JT, Schwinghammer TL, et al. Pharmacotherapy
Handbook. 8th ed. New York: McGraw-Hill, 2012.
- Most commonly diagnosed cancer in American men
- Use of finasteride for treatment of benign prostatic hypertrophy
(BPH) decreased prostate cancer risk by ~25%.
cancer diagnosed in patients on finasteride is more aggressive.
- Current guidelines do not recommend use of finasteride or dutaseride for prostate cancer chemoprevention.
- Current practice: baseline prostate-specific antigen (PSA)
and digital rectal exam (DRE) at age 40 with annual evaluations
beginning at age 50 for men of normal risk.
testing recommended for men at higher risk for prostate cancer.
- Despite common practice, screening controversial.
- Possible risk factors include:
- Family history
- Other risk factors include:
- Most prostate cancers identified prior to development
- Localized prostate cancer usually asymptomatic.
- Locally invasive disease
- Ureteral dysfunction
- Urinary frequency, hesitancy, and dribbling
- Advanced disease
- Back pain
- Spinal cord compression
- Lower extremity edema
- Weight loss
- Pathologic fractures
Means of Confirmation
- Prostate-specific antigen (PSA)
- Complete blood count (CBC)
- Metabolic panel
- Chest radiograpy
- Bone scan
- Transrectal ultrasonography (TRUS)
- If DRE
positive or PSA elevated
- Digital rectal examination (DRE)