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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.

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  • Malignant neoplasm that arises from prostate gland

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  • Hormonal, dietary, and genetic differences may contribute to altered susceptibility in certain populations.

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  • 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.

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Figure 1.
Graphic Jump Location

Hormonal regulation 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.

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  • Most commonly diagnosed cancer in American men

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Chemoprevention

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  • Use of finasteride for treatment of benign prostatic hypertrophy (BPH) decreased prostate cancer risk by ~25%.
    • Prostate cancer diagnosed in patients on finasteride is more aggressive.
    • Current guidelines do not recommend use of finasteride or dutaseride for prostate cancer chemoprevention.

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Screening

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  • 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.
    • Earlier testing recommended for men at higher risk for prostate cancer.
  • Despite common practice, screening controversial.

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  • Possible risk factors include:
    • Age
    • Race-ethnicity
    • Family history
  • Other risk factors include:
    • Environment
    • Occupation
    • Diet

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  • Most prostate cancers identified prior to development of symptoms.
    • Localized prostate cancer usually asymptomatic.

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Signs and Symptoms

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  • Locally invasive disease
    • Ureteral dysfunction
    • Urinary frequency, hesitancy, and dribbling
  • Advanced disease
    • Back pain
    • Spinal cord compression
    • Lower extremity edema
    • Anemia
    • Weight loss
    • Pathologic fractures

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Means of Confirmation and Diagnosis

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  • Results from biopsy

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Laboratory Tests

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  • Prostate-specific antigen (PSA)
  • Complete blood count (CBC)
  • Metabolic panel

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Imaging

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  • Chest radiograpy
  • Bone scan
  • Transrectal ultrasonography (TRUS)
    • If DRE positive or PSA elevated

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Diagnostic Procedures

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  • Digital rectal examination (DRE)
  • Biopsy

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Staging

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