Question

1. Discuss a women's health or men's health topic of interest to you. (Include condition, signs & symptoms, prevalence, incidence, treatment) 2. Do you know someone with the condition? If so, how is it being managed?

Answer 1

1. PROSTATE CANCER

Prostate cancer is cancer that occurs in the prostate a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm.

Prostate cancer is one of the most common types of cancer in men. Usually prostate cancer grows slowly and is initially confined to the prostate gland, where it may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.

Signs and Symptoms

Currently, most cases of prostate cancer are identified by screening in asymtomatic men.Symptoms of prostate cancer include the following:

• Urinary complaints or retention
• Back pain
• Hematuria

Findings in patients with advanced disease may include the following:

• Cancer cachexia
• Bony tenderness
• Lower-extremity lymphedema or deep venous thrombosis
• Adenopathy
• Overdistended bladder due to outlet obstruction

PREVALENCE & INCIDENCE

The incidence of prostate cancer varies across the regions and populations. In 2018, 1,276,106 new cases of prostate cancer were registered worldwide, representing 7.1% of all cancers in men. Prostate cancer incidence rates are highly variable worldwide. The age-standardized rate (ASR) was highest in Oceania (79.1 per 100,000 people) and North America (73.7), followed by Europe (62.1). Conversely, Africa and Asia have incidence rates that are lower than those from developed countries (26.6 and 11.5 respectively). Differences in incidence rates were 190-fold between the populations at the highest rate (France, Guadeloupe, 189.1), and the populations with the lowest rate (Bhutan, 1.0).

TREATMENT

Goals of treatment

In early-stage prostate cancer, the goal is to minimize morbidity and mortality. Surgery and radiation therapy are curative but also associated with significant morbidity and mortality. In advanced prostate cancer, treatment focuses on providing symptom relief and maintaining quality of life.

Non Pharmacologic Therapy

1. Observation

• Observation or watchful waiting involves monitoring the course of disease and initiating treatment if the cancer progresses. PSA and DRE are performed every 6 months.
• Advantages include avoiding adverse effects of definitive therapies and minimizing risk of unnecessary therapies. The major disadvantage is the risk of cancer progression requiring more intense therapy.

2. Surgery and Radiation Therapy

• Bilateral orchiectomy rapidly reduces circulating androgens to castrate levels.
• Radical prostatectomy and radiation therapy are potentially curative therapies but are associated with complications that must be weighed against expected benefit.
• Complications of radical prostatectomy include blood loss, stricture formation, incontinence, lymphocele, fistula formation, anesthetic risk and impotence.
• Acute complications of radiation therapy include cystitis, proctitis, hematuria, urinary retension, penoscrotal edema and impotence.
• Chronic complications of radiation therapy include proctitis, diarrhea, cystitis, enteritis, impotence, urethral stricture and incontinence.

Pharmacologic Therapy

Luteinizing Hormone- Releasing Hormone Agonists

• LHRH agonists are a reversible method of androgen ablation and are effective as orchiectomy.
• Leuprolide acetate, leuprolide depot, leuprolide implant, triptorelin depot, triptorelin implant and goserelin acetate implant are currently available.
• Dosing intervals range from once monthly to every 16 weeks. Leuprolide implant is a mini osmotic pump that delivers daily doses for 1 year.
• ADR of LHRH include hot flashes, erectile impotence, decreased libido and injection site reactions.

Gonadotropin- Releasing Hormone Antagonists

• The GnRH antagonist degarelix binds reversibly to GnRH receptors in the pituitary gland, reducing the production of testosterone to castrate level i 7 days or less.
• A major advantage of degarelix over LHRH agonists is the lack of tumor flare.

Antiandrogens

• Antiandrogens are indicated for advanced prostate cancer only when combined with an LHRH adonist or orchiectomy. In combination antiandrogens can reduce the LHRH agonist-induced flare.
• Enzalutamide is approved as a single agent in metastatic hormone resistant prostate cancer patients whp have previously received docetaxel.

2. A 64 year old male patient come with complaints of back pain, hematuria, bony tenderness and adenopathy. The PSA levels are also elevated. Biopsy was also performed and the test was positive. And he is managed with radical prostectomy.