U Assessment

HISTORY. Ask about family history of prostate cancer, an occupational exposure to cadmium, and the usual urinary pattern. A patient may report symptoms such as urinary urgency, frequency, nocturia, dysuria, slow urinary stream, impotence, or hematuria if the disease has spread beyond the periphery of the prostate gland or if benign prostatic hypertrophy is also present. Presenting symptoms that include weight loss, back pain, anemia, and shortness of breath are often indicative of advanced or metastatic disease.

PHYSICAL EXAMINATION. Most men with early-stage prostate cancer are asymptomatic. The physician palpates the prostate gland via a digital rectal examination. A normal prostate gland feels soft, smooth, and rubbery. Early-stage prostate cancer may present as a nonraised, firm lesion with a sharp edge. An advanced lesion is often hard and stonelike with irregular borders. A suspicious prostatic mass is further evaluated by extending the examination to the groin to look for the presence of enlarged or tender lymph nodes.

PSYCHOSOCIAL. Men have reported not having a rectal exam because of embarrassment. In addition, treatment for prostate cancer can be accompanied by distressful side effects, such as sexual dysfunction and urinary incontinence. Assess the patient's knowledge and feelings related to these issues and the presence of support systems. Note the coping strategies the patient has used in the past to manage stressors. Include the patient's spouse or significant other in conversations.

Diagnostic Highlights

General Comments: Positive findings during the digital rectal exam and an elevated PSA suggest the diagnosis. Other tests may be needed to confirm and determine metastasis.

Test

Normal Result

Abnormality with Condition

Explanation

Prostate specific antigen (PSA)

<4 ng/mL

Increased levels, >10 ng/mL

The higher the level, the greater the tumor burden; can be used to monitor response to treatment or recurrent cancer (CA)

Transrectal ultrasound (TRUS)

Biopsy

Prostate gland is of normal size, contour, and consistency

Benign

Enlarged, solid prostate mass is noted

Malignant

Can identify prostatic CA early; very small tumors can be detected

Confirms the diagnosis

Other Tests: Computed tomograpy (CT) scan of the abdomen and pelvis, magnetic resonance imaging (MRI), lymphangiogram, intravenous pyelogram, chest x-ray, bone scan, laparoscopic pelvic lymphadenectomy, serum reverse transcriptase-polymerase chain reaction (RT-PCR), and acid phosphatase level.

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