Abnormal digital rectal examination findings
Various factors are considered when a DRE is performed. A nodule is important, but findings such as asymmetry, difference in texture, and bogginess are important clues to the patient’s condition and should be considered in conjunction with the PSA level. Change in texture over time can offer important clues about the need for intervention. Cysts or stones cannot be accurately differentiated from cancer based on DRE findings alone; therefore, maintain a high index of suspicion if the DRE results are abnormal. In addition, if cancer is detected, the DRE findings form the basis of clinical staging of the primary tumor (ie, tumor [T] stage in the tumor node metastases [TNM] staging system). In current practice, the DRE results are normal but the PSA readings are abnormal in most patients diagnosed with prostate cancer.
Local Symptoms
In the pre-PSA era, patients with prostate cancer commonly presented with local symptoms. Urinary retention developed in 20-25% of these patients, back or leg pain developed in 20-40%, and hematuria developed in 10-15%. Currently, with PSA screening, patients report urinary frequency (38%), decreased urine stream (23%), urinary urgency (10%), and hematuria (1.4%). However, none of these symptoms is unique to prostate cancer and each could arise from various other ailments. Forty-seven percent of patients are asymptomatic.
To summarize, the steps to diagnosis of Ca Prostate may be outlined as follows:
1 |
DRE - Digital Rectal Examination |
2 |
Biochemical – PSA, PAP |
3 |
Radiological – Ultrasound scan, IVU, Skeletal Survey, CT Scan |
4 |
Prostatic Biopsy |
TREATMENT
We usually consider the following modalities based on the peculiarity of the patient involved:
1.Watchful waiting
- Elderly men with very short life expectancy
- Old patients expected to live for a very short period because of other illnesses.
2. Medical
- Drugs e.g. Stilboesterol, Gosarelin(Zoladex)
- Other therapy
- Bilateral Orchidectomy (Castration)
3. Surgery
- Radical Prostatectomy – extensive surgery (rarely practiced now)
- Radiotherapy
- Laser therapy (Palliative) Radiation and prostate cancer surgery, or prostatectomy, are the two most common treatments for localized disease. Treatment for advanced prostate cancer includes hormonal therapy and chemotherapy.
PREVENTION
General Principles of Disease Prevention
There are three basic types of prevention: primary, secondary, and tertiary (Figure 1). Primary focuses on prevention of incident disease in at-risk populations, secondary on attenuating the severity of prevalent disease through early detection and intervention, and tertiary on halting disease progression and recurrence in patients. All three types of prevention have prominent functions in the management of prostate cancer.
SUMMARY
Diseases of the prostate require appropriate evaluation and treatment. It is important to detect cancer early and institute appropriate treatment.
Regular medical checkup is very key. When last were you checked or your spouse?
ARE YOU A PUTOLOGIST?
Last week, I learned a new word from a client that I am certain is not in Webster’s Dictionary. Are you a
“Putologist?” Here is how you know.
Do you “put” things or conversations off, hoping to act on then later? Do you “put” objects down or shuffle papers on your desk thinking that you will file or put them away at another time? Do you “put” things in places, constantly organising and never getting to what is really important or fulfilling?
When we put things off or do not put them away, our anxiety grows. Dread builds as we tolerate the incompletion. We become stressed about the task at hand and it looms larger. It takes on a life of its own.
Putting off conversation often robs us of joy. It is like a low-grade fever running in the background. When we address it, the anxiety often disappears.
By eliminating these tolerations we can put stress and joy in their proper places.
Culled from Leadership Tips of Mary Ann Masur
