PBL 2: A 62 year old man presented to the GP with an increased tenderness of the pubic region
Discuss the common types of disease that may be causing these symptoms and suggest a likely diagnosis for this patient
The patient is a 62 year old male who presented to the GP with an increased tenderness of the pubic region, his systems also included increased frequency of urination. His blood profiles were normal except for prostate specific antigen (PSA) level of 10ng/ml, which significantly above normal for a man of 62 years (which is 4ng/ml). This increased PSA level is indicative of three conditions, prostate cancer, prostatitis and an enlarged prostate (James Catto, 2009).
Prostate cancer is a cancer of the prostate gland; it may
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Of the 4 types the chronic pelvic pain syndrome is the most likely; he lacks any bacterial infection and is presenting with symptoms, ruling the other 3 subtypes of this condition out (Prostate Cancer UK, 2013a).
An enlarged prostate (also known as benign prostatic hyperplasia) may also be responsible for the increases PSA and urinary problems. It is a common condition affecting 40% of men over 50; and it accounts for the patients urinary problems (Prostate Cancer UK, 2013b). A transurethral resection of the prostate (TURP) may be performed if BHP was suspected.
As prostatitis has a low risk (<10%) and the transrectal ultrasound showed no significant results I am ruling it out as a likely diagnosis (Krieger et al, 2008). Biopsies would only be taken if cancer was suspected, as it would allow for a definitive diagnosis of cancer; it would also allow for a definitive diagnosis if cancer or benign prostatic hyperplasia were both suspected. A likely diagnosis for this patient would be prostate cancer.
What is the aetiology and pathogenesis of the disease suggested as your likely diagnosis?
Another method to detect this cancer is with a Prostate Specific Antigen (PSA). Protein in the blood that is produced only by prostate cells is reflected the volume of both benign and malignant prostate tissue in the PSA. The higher the PSA level is the more likely it is that Prostate Cancer present. (“Prostate
Benign prostate hyperplasia (BPH) and prostate cancer share a few similarities, elevated prostate-specific antigen (PSA). Along with enlargement of prostate gland that causes urinary symptoms such as, frequent urination, hesitancy, dribbling, and frequent nighttime urination. However, they are quite different which is why more tests need to be done to confirm one or the other condition. These two diseases are also similar in the fact that they both cause an enlargement of the prostate. However with BPH the central portion of the prostate is enlarged and with prostate cancer more commonly the lateral lobes or side of the prostate are enlarged, but can affect any were on the prostate. Both can even be detected by a digital rectal exam however
Prostate cancer is the most common type of cancer in American men after skin cancer. There are many risk factors that increase the disease such as age, being the far most important risk factor, along with race, family history and diet (ASCO, 2015). The prostate is a walnut shaped gland of the male reproductive system that functions to create part of the semen, which is fluid in which sperm swim in when ejaculation occurs. It is located inferior to the bladder, anterior to the rectum, surrounding the urethra. For this reason, when a prostate becomes abnormal, many signs and symptoms manifest themselves when a male urinates. When the prostate becomes enlarged by cancer or any other disease, it blocks the neck of the urethra causing a weak stream,
Prostate cancer is the second most common cancer and it is the second leading cause of cancer death in American men according to the American Cancer Society(ACS) ( 2016). Older age is the strongest risk factor for the development of prostate cancer. Approximately 1 in 7 men will be diagnosed with prostate cancer during his lifetime (ACS, 2016). There are more than 2.9 million prostate cancer survivors in the United States (ACS, 2016). The risk of dying from prostate cancer is 2.9 percent, with seventy percent of deaths occurring after age 75(ACS, 2016; Howlader, Krapcho, Neyman,Aminou et al, 2011). The use of the prostate-specific antigen testing transformed prostate cancer screening in the 1990’s (Up to date) . PSA screening for prostate
Prostate cancer is one of the major health concerns of the public. Worldwide prostate cancer has affected a big portion of the population and has become an issue for many males all around the world. Prostate cancer refers to the malignant growth of glandular cells located in the prostate. At the age of 85, a man is said to have a 1 in 5 chances of developing prostate cancer sometime in their life. Unfortunately Prostate cancer is a disease that does not give any warning signs when it is growing and so the clinical features of prostate are often nonspecific. Patients with prostate cancer have different types of treatment in which they can accept, there can be various methods such as surgery and theraypy toptions. There are
Research has indicated that prostate cancer is more likely to be observed rather than treated directly. These observations come from the University of California, San Francisco, where the concerns of overtreatment are being addressed.
The risk of prostate cancer is the greatest for American males. The symptoms of prostate cancer are; frequent urination especially at night, difficulty starting urination or holding back urine, weak or interrupted flow of urine, painful or burning urination, difficulty having an erection, painful ejaculation, blood in urine or semen, and frequent pain or stiffness in the lower back, hips, or upper thighs. Prostate cancer is diagnosed by digital rectal examination, prostate-specific antigen blood test, and transrectal ultrasound. Also, tissue biopsy, microscopic examination, lymphography, bone scans, MRI and CT scans are used to confirm a diagnosis. Prostate cancer is treated is based upon the stage of the disease. Some of the various treatments
FDA has approved Prostate Specific Antigen (PSA) assessment for screening for PCa. However, ubiquitous application of PSA screening has also led to over detection and over treatment of PCa. Patients with elevated PSA, with a cancer suspicion, are subjected to prostate biopsy for further examination. However, these prostate biopsies often miss the target (neoplastic tissues) and hit the normal tissue for sampling, and as a result, the prostate cancer goes undetected. Hence, transrectal ultrasound (TRUS) is used to help the physician properly place the needle, which is projected through the tip of a probe inserted into the rectum to the prostate.
al were able to calculate the amount of PSA produced per gram of benign prostatic
In the case with over diagnosing, the screening process for determining if a person has prostate cancer. The US Preventive Service Task Force (USPSTF) states, “the potential benefit of testing does not outweigh the expected harms” meaning there can be more harm than good. The controversy fixed whether prostate-specific antigen (PSA) testing being suitable and helpful when diagnosing prostate cancer. It is recommended that the doctor talks to the patient about how they are feeling and listen to them if they are having difficulties urinating. The doctor can also examine the prostate itself by performing a Digital rectal exam (DRE). The other controversy is over-treatment of prostate cancer. Its controversial due to the medication the person and haw potently they are, ““infection or inflammation of the prostate (prostatitis) may increase the chance for prostate cancer while another study shows infection may help prevent prostate cancer by increasing blood to the area.” Every man’s body is different and is going to react differently to
Prostate cancer affects the urethra and the bladder. That is why men who have prostate cancer are likely to have urinary problems. They may have to get up frequently in the middle of night to go to the restroom. It is also common for a man with prostate cancer to experience a burning sensation while urinating.
Second is age- and race-specific PSA reference ranges. Age- and race-specific PSA reference ranges compare the PSA test results among men in the same group. Third is Percent-free PSA (fPSA) is the percentage of the total PSA that is unbound. Evidence suggests that fPSA is lower in men who have prostate cancer compared with men who do not. Fourth are the complexed PSA (cPSA) test measures the amount of bound PSA circulating in the blood. Fifth is the PSA density (PSAD) which is a test sometimes used by doctors in patients who have a large prostate gland. To determine PSAD, the PSA value (ng/mL) is divided by the volume (size in cubic centimeters) of the prostate. The size of the prostate gland is determined by Tran’s rectal ultrasound (TRUS), a procedure that uses sound waves to create a picture of the prostate. ( (Diagnosis))
Benign prostatic hyperplasia also called BPH is a condition that occur in men because of the enlargement of the prostate gland that have no linkage to cancer but is identified as a benign tumor as a result of a prostate obstruction in urination. It can be either acute or chronic but it’s mainly chronic and have a steady growth process. Acute benign prostatic hyperplasia is sudden onset due to reflux of voiding such as urinary retention (inability to urinate or postponing voiding). Chronic benign prostatic is gradual and ongoing onset and largely developed from complications of bladder dysfunction and kidney damage. Benign prostatic hyperplasia is normal but symptoms can be prevented with a proper nutritional diet,
Arguably the most essential and indispensable aspect of life is the attainment and preservation of good health. Individuals with health-related complications are often prevented from leading what many would consider to be a normal lifestyle. One of the several ailments that impedes typical human functioning is prostate cancer. The community of experts and professionals who have dedicated their lives to this field of study are, at this time, engaged in a substantive yet divisive and strongly opinionated dispute regarding a test considered by some to aid in the detection of this cancer. This highly scrutinized test is known as the prostate-specific antigen test, more commonly referred to as the PSA test. In the United States and more broadly
Serum prostate-specific antigen (PSA) level is generally used as a screening test for asymptomatic patients. Patients with elevated serum PSA level and/or abnormal digital rectal examination undergo Transrectal ultrasound (TRUS) guided biopsy to detect early prostatic carcinoma. The histological grade of the cancer usually assessed using the Gleason grading system is currently the world’s best grading histological system for prostate cancer.