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Prostate cancer is a tumor found within a secretory gland (prostate) located within the male reproductive system. The prostate gland is about the size of a chestnut and surrounds the neck of the urinary bladder and the tube that carries urine away from the bladder (urethra). The prostate secretes fluid into the semen during ejaculation. The cancer is usually slow growing and commonly discovered during routine screening. Prostate cancer is often an incidental finding at autopsy after death from other causes.
Risk: Before age 50 developing prostate cancer is unlikely, but the risk increases substantially as men get older; half of prostate cancer cases are diagnosed in men greater than the age of 75 (Clements). Race may also be a factor as the probability of a black male developing prostate cancer is 100 cases out of 100,000 compared with 70 cases out of 100,000 for a white male (Clements). Other risk factors include a family history of prostate cancer, certain occupational exposures such as cadmium and tire or rubber manufacturing, and a high-fat diet. Incidence and Prevalence: Malignancy of the prostate is the number one cause of diagnosed cancer in American males (other than skin cancer), and is the second leading cause of cancer deaths among men: approximately 220,900 new cases of prostate cancer were diagnosed in the year 2003; prostate cancer accounts for 28,900 deaths (Clements). |
Source: Medical Disability Advisor
| History: Early prostate cancer may not exhibit any symptoms and may only be detected on screening examination by digital rectal exam (DRE) and prostate specific antigen (PSA). The individual may report frequent urination, a weak or interrupted urine stream, straining to urinate, difficulty starting urination or holding back urine, and pain or burning during urination though these symptoms will more often be caused by benign prostatic hyperplasia (BPH). Bone pain is a common symptom of advanced prostate cancer as a result of spread (metastasis) of the tumor to bones such as the spine, pelvic bones, and ribs. Pain in the lower back, pelvis, or thighs may be reported if the tumor has metastasized into the pelvic nerves. Stool changes and painful defecation are common if the tumor has grown large enough to cause rectal obstruction. Painful ejaculation and blood in the urine or semen are also symptoms of advanced prostatic cancer. Physical exam: Annual screening for prostate cancer after ages 45 to 50 is done by inserting a gloved lubricated finger into the rectum and feeling the prostate gland for any irregularity or firm area that may be cancer (digital rectal examination). In their 30's, 27% of males will have prostatic tumors that are too small to be detected by rectal examination (Reiter 3017). Greater than half of males have advanced prostate cancer when it is discovered by digital rectal examination (Nelson 2096). Tests: Biochemical screening using prostate-specific antigen (PSA) is combined with digital rectal exam for men over 50 and men at high-risk at age 45. If symptoms or the result of a DRE or PSA suggests prostatic cancer, further tests are conducted. A definitive diagnosis is made by taking a sample of tissue from the tumor within the prostate (needle biopsy) to determine if it is cancerous. A grade is assigned to the tissue based on how closely it resembles normal tissue (Gleason score). Based on the DRE, PSA and Gleason score additional tests may be conducted to determine how far the cancer has spread. These tests include high-frequency sound waves (transrectal ultrasound or TRUS), CT, and MRI. Intravenous pyelogram (IVP) is an x-ray study of the urinary tract after intravenous injection of a dye that concentrates in the urine. Cystoscopy allows the doctor to look into the urethra and bladder through a thin, lighted tube. CT may also be used in combination with radioactively labeled antibodies that bind to the prostate and allow better visualization of the tumor (radioimmunoscintigraphy). Bone x-rays, bone scan, or chest x-ray may reveal spread of tumor to the bones or lungs. |
Source: Medical Disability Advisor
| Treatment for prostate cancer depends on the grade and stage of the disease, individual's age, general health, and treatment preference. No treatment (watchful waiting) is appropriate for individuals with localized tumors that have a very low progression rate and a high disease-specific survival rate. This usually includes men in their 60s or 70s and individuals with less than a 10-year life expectancy due to comorbid conditions.
Men who are at high-risk, who have moderate to high-grade tumors, and men in their 40s and 50s with life expectancy of more than 10 years usually opt for surgical, radiation or hormone treatment. Surgical removal of the prostate, seminal vesicles, and part of the vas deferens but (radical prostatectomy) is a common treatment for early stage tumors found in younger individuals in excellent health and who are expected to live at least 15 more years. For very early disease in older men, only the prostate tissue may be removed (simple prostatectomy). These surgeries are often curative for cancer that has not metastasized into lymph nodes or other organs. Individuals with more advanced tumors are usually not candidates for this type of surgery. However, in some cases surgical removal of the tumor (transurethral resection of the prostate or TURP) may be useful to relieve urinary obstruction or other symptoms. A different surgical option for localized tumors is destruction of the tumor by insertion of a probe that alternately freezes and thaws the tissue (cryosurgery).
Radiation therapy is an alternative primary treatment to surgery. Radiation can be delivered from an external x-ray machine (external beam radiotherapy) and/or by surgical implantation of radioactive pellets into and around the prostatic tumor (brachytherapy). Brachytherapy has advantages over external beam therapy in that it allows delivery of a high, localized dose to the tumor while minimizing the dose to surrounding normal tissue. The use of brachytherapy depends on accessibility of the tumor, the ability to accurately place the radioactive sources, and types of sources available. In some individuals, brachytherapy may be used in combination with other treatments such as external beam radiation and/or androgen deprivation therapy.
Individuals with advanced prostate cancer are most often treated by blocking the effects of the male sex hormone (testosterone) or by decreasing the amount of testosterone in the body (both treatments are termed androgen deprivation therapy). Androgen deprivation therapy is used for individuals with cancer that has spread beyond the prostate, as it relieves symptoms and slows the progression of the disease. Surgery to remove the testicles (orchiectomy) is one approach to removing testosterone.
Drugs that block the binding site (receptor) for testosterone decrease the growth-promoting effects that the male sex hormone has on prostatic tumors. The amount of testosterone in an individual's body can be decreased using drug therapy with either female sex hormone (estrogen) or luteinizing hormone releasing hormone (LHRH) agonists. Both of these inhibit testosterone secretion. Drug therapy using estrogen is usually not employed because of undesirable side effects such as breast enlargement and increased risk of heart failure.
Chemotherapy is considered if the patient has failed hormonal therapy and has metastatic prostate cancer. Multiple chemotherapy drugs have been tested for their effectiveness in treating prostate cancer that has metastasized into other organs, although no clinical trials have confirmed that the treatment improves survival rates. |
Source: Medical Disability Advisor
| The choice of therapy for individuals with prostate cancer depends on the stage, and grade of the tumor when diagnosed as well as the age of the patient, general state of health, treatment goals and concerns about side effects. The patient's survival is determined by the stage and grade of the tumor, which guides what type of treatment they receive. Individuals with localized tumors treated by watchful waiting have a 10-year survival rate ranging from 50% to 73%; radical prostatectomy has 10-year survival rates for localized tumors that range from 80% to 95% (Theodorescu). In one study on cryosurgery for localized disease in patients who had failed radiation therapy after surgery, 74% of patients were free of cancer for 2 years (Theodorescu). Radiation therapy and brachytherapy treatment combined have 10-year survival rates for localized tumors of 80% to 95% (Theodorescu). Half of individuals with localized tumors get worse even with treatment (Qureshi).
Individuals with metastatic prostate cancer treated with androgen deprivation therapy die of the disease within 3 years; however, the extent of the metastasis produces variable survival rates (Qureshi). |
Source: Medical Disability Advisor
| Appropriate therapy for individuals with prostate cancer includes nutritional support, effective pain management, relevant palliative care, and social support. Following surgery for prostate cancer, intermittent positive pressure breathing exercises may help prevent postoperative pulmonary complications. Certain exercises may reduce postoperative pain and speed recovery including progressive relaxation and deep breathing techniques.
Physical therapy improves ventilation through breathing exercises that are localized to the area of involvement and then followed by a gradual strengthening program.
Physical therapy or consultation with a continence specialist may be needed following surgery to promote bladder control. Pelvic muscle exercises (Kegel exercises) performed on a routine basis for as long as a year following surgery can often eliminate or improve incontinence.
A dietitian is important in the supervision of dietary requirements for individuals undergoing surgery or receiving nonsurgical treatments. The frequency and duration of the rehabilitation program will vary among individuals with prostate cancer. Intensity and progression of exercise depend on the prognosis, if surgery was performed, if individual is receiving any current cancer treatment, the extent of the disease, and individual's overall health. |
Source: Medical Disability Advisor
| Complications of early prostate cancer are often related to diagnostic procedures and/or treatment. Needle biopsy is a minimally invasive procedure but carries a slight risk of bleeding and infection. Radical prostatectomy often results in erectile dysfunction (impotence) and/or inability to control urination (urinary incontinence). Both of these conditions may be either temporary or permanent. Radiation therapy may also result in a gradual loss of erectile function as well as acute or chronic diarrhea, fatigue, skin changes, and hair loss in the irradiated area. Hormone therapy can cause loss of sexual desire and function and hot flashes. Depending on the drugs used, chemotherapy may cause susceptibility to infections, immune system compromise, fatigue, vomiting, bleeding tendencies, or hair loss.
Complications of advanced prostate cancer may occur as a direct result of the disease. Enlargement of the primary tumor may obstruct the urinary tract which can lead to urinary tract infections. The tumor may cause neurological dysfunction and/or pain if it grows large enough to press on nerves lying in or near the prostate. If the tumor is large enough to block the lymphatic system (lymphatic obstruction), the lower extremities may swell (lymphedema). If the tumor has metastasized, other complications may occur depending on the organs involved. Spread of the tumor into the spinal column can lead to compression fractures of the vertebrae or spinal cord compression with paralysis. Prostatic tumors may enter the lymphatic system resulting in a neoplasm of lymphoid tissue (lymphoma).
Treatment of advanced prostate cancer can produce complications including adverse effects of hormonal therapy such as impotence, breast enlargement, nausea, hot flashes, adrenal insufficiency, liver toxicity, and blood clotting (thromboembolism). Orchiectomy may result in permanent erectile dysfunction and sterility. Adverse effects of chemotherapy include nausea and vomiting, hair loss, and depressed immunity due to bone marrow toxicity. |
Source: Medical Disability Advisor
| Return to work may be facilitated by temporary restrictions and/or accommodations depending on the extent of the cancer and type of treatment. For example, incontinent individuals may need to take frequent bathroom breaks. Individuals with advanced, symptomatic disease may be work-restricted due to pain, fatigue, and general debilitation. Some individuals may require more sedentary work for a period of time due to weakness and fatigue following surgery, radiation therapy, or chemotherapy. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- How old is individual? Ethnic background?
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Does individual have a family history of prostate cancer? History of exposure to cadmium and tire or rubber manufacturing?
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Does individual have high-fat diet?
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Does individual report frequent urination, a weak or interrupted urine stream, straining to urinate, difficulty starting urination or holding back urine, and pain or burning during urination? Stool changes? Painful defecation? Painful ejaculation? Blood in the urine or semen?
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Does individual report bone pain in the spine, pelvic bones, or ribs?
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Has individual had a digital rectal examination?
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Was ultrasound, CT, MRI, IVP, or cystoscopy done? Radioimmunoscintigraphy? Biopsy? Were bone x-rays, bone scan, or chest x-ray for staging done?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Does individual's treatment consist of watchful waiting?
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Has individual had a simple or radical prostatectomy done?
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Did individual have external radiation therapy? Radioactive pellets?
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Was androgen deprivation therapy done? Chemotherapy?
Regarding prognosis:
- Can individual's employer accommodate any necessary restrictions?
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Does individual have any conditions that may affect ability to recover?
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Have any complications developed such as erectile dysfunction, urinary incontinence, acute or chronic diarrhea, fatigue, skin changes, hot flashes, susceptibility to infections, immune system compromise, vomiting, bleeding tendencies or hair loss? Does the individual have lymphedema or metastasis?
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Source: Medical Disability Advisor
| Clements, Richard. "Prostate Carcinoma." eMedicine. Eds. Mario Bezzi, et al. 5 Jul. 2004. Medscape. 18 Jan. 2005 <http://emedicine.com/radio/topic574.htm>.Qureshi, Shaukat. "Prostate Cancer: Metastatic and Advanced Disease." eMedicine. Eds. Martha Terris, et al. 5 Jul. 2004. Medscape. 18 Jan. 2005 <http://emedicine.com/med/topic3197.htm>. Reiter, Robert E., and Jean B. deKernion. "Epidemiology, Etiology, and Prevention of Prostate Cancer." Campbell’s Urology. Eds. Patrick C. Walsh, et al. 8th ed. 4 vols. Philadelphia: W.B. Saunders, 2002. 3001-3226. MD Consult. Elsevier, Inc. 18 Jan. 2005 <http://home.mdconsult.com/das/book/43188473-2/view/1049?sid=323780308>. Theodorescu, Dan, and Tracey L. Krupski. "Prostate Cancer: Management of Localized Disease." eMedicine. Eds. Edward David Kim, et al. 20 Aug. 2004. Medscape. 18 Jan. 2005 <http://emedicine.com/med/topic3186.htm>. William, Nelson G., et al. "Prostate Cancer." Clinical Oncology. Eds. Martin D. Abeloff, et al. 3rd ed. Philadelphia: Churchill Livingstone, Inc., 2004. 2085-2133. MD Consult. Elsevier, Inc. 18 Jan. 2005 <http://home.mdconsult.com/das/book/43188473-2/view/1241?sid=323780308>. |
Source: Medical Disability Advisor
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