Prostate cancer is the most common cancer among men, excluding skin cancer, and second leading cause of cancer-associated death. One in every six men develops prostate cancer, and typically happens in men over the age of 65.
Prostate cancer is typically asymptomatic in the early stages, but can present with symptoms similar to those in BPH. This includes dysuria, urinary hesitancy, dribbling, hematuria, nocturia, and urgency.
Preferentially, prostate cancer metastasizes to the bones. Often, it spreads to nearby vertebrae, leading to compression of the spinal cord and destruction of the bone.
Low back pain is a common complaint in patients with lumbosacral vertebral metastases from prostate cancer. Typically, the pain is described as radiating down to the hips or the legs.
Patients with malignancy often complain of fatigue, and this is the case with prostate cancer. The complaint of chronic, debilitating fatigue may be a sign that the prostate cancer is advanced.
Prostate specific antigen, or PSA, is a lab test that can help confirm the diagnosis of prostate cancer. It should be noted that this test is very nonspecific and can falsely be elevated for a variety of reasons. Another test that can be used is the PAP or prostatic acid phosphatase.
A digital rectal examination, or DRE, can be done on physical exam if there is a suspicion of prostate cancer, and men who fit the criteria for screening can have a yearly exam. An abnormal prostate may feel hard, nodular, and asymmetric.
If there is a high suspicion of prostate cancer, a transrectal ultrasound (TRUS) can be used to visualize the prostate for abnormalities. A TRUS is also used to help guide the physician when obtaining a needle biopsy.
If necessary, a biopsy of the prostate is taken with a needle. A definitive diagnosis can be made only after examining the pathologic specimen for malignant changes.
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