1. Age (not seen in men < 40 years old; incidence increases with age; 60% of men >.80 have prostate cancer)
Patients present late, because early prostate cancer is asymptomatic. Look, for symptoms suggestive of benign prostatic hypertrophy (hesitancy, dysuria, frequency) with hematuria and/or elevated prostate-specific antigen (PSA) or acid phosphatase. Acid phosphatase is elevated only when the cancer has broken through the capsule; for this reason, it was replaced with the more sensitive PSA as a screening tool. Look for prostate irregularities (nodule) on rectal exam. Patients also commonly present with back pain from vertebral metastases (osteoblastic).
Local prostate cancer is treated with surgery (prostatectomy). Patients with metastases have several options for hormonal therapy: orchiectomy, gonadotropin-releasing hormone agonist (leuprolide), androgen-receptor antagonist (flutamide), estrogen (diethyistilbestrol), and others (e.g., cyproterone). Chemotherapy does not work, and radiation therapy is used for local disease or pain from bony metastases.
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