News & Perspective
Drugs & Diseases
CME & Education
Academy
Video
Decision Point
Edition: English

Medscape

English
Deutsch
Español
Français
Português
UKNew

Univadis

Sign Up It's Free!
English Edition

Medscape

Univadis

    X
    Univadis from Medscape

    No Results

      News & Perspective Drugs & Diseases CME & Education Academy Video Decision Point
      Drugs & Diseases > Urology

      Prostate Cancer Clinical Presentation

      Updated: Jan 20, 2023
      • Author: Chad R Tracy, MD; Chief Editor: Edward David Kim, MD, FACS  more...
      • Print
      Presentation

      History

      Currently, the majority of prostate cancers are identified in patients who are asymptomatic. Diagnosis in such cases is based on elevation of the prostate-specific antigen (PSA) level on a screening study or findings on digital rectal examination (DRE). In addition, prostate cancer can be an incidental pathologic finding when tissue is removed during transurethral resection to manage obstructive symptoms from benign prostatic hyperplasia.

      Symptoms of local disease

      In the pre-PSA era, patients with prostate cancer commonly presented with symptoms that included urinary complaints or retention, back pain, and hematuria. Currently, with PSA screening, most prostate cancers are diagnosed at an asymptomatic stage. When symptoms do occur, diseases other than prostate cancer may be the cause. For example, urinary frequency, urinary urgency, and decreased urine stream often result from benign prostatic hyperplasia.

      Symptoms of advanced disease

      Advanced prostate cancer results from any combination of lymphatic, hematogenous, or contiguous local spread. Skeletal manifestations are especially common because prostate cancer has a strong predilection for metastasizing to the bone.

      Manifestations of metastatic and advanced prostate cancer may include the following:

      • Weight loss and loss of appetite
      • Anemia
      • Bone pain, with or without pathologic fracture
      • Neurologic deficits from spinal cord compression
      • Lower extremity pain and edema due to obstruction of venous and lymphatic tributaries by nodal metastasis

      Uremic symptoms can occur from urethral obstruction caused by local prostate growth or retroperitoneal adenopathy secondary to nodal metastasis.

      Next:

      Physical Examination

      Physical examination (ie, digital rectal examination [DRE]) alone cannot reliably differentiate benign prostatic disease from cancer. Consequently, a biopsy is warranted to establish a diagnosis. Unfortunately, false-negative results often occur, so multiple biopsies may be needed before prostate cancer is detected.

      If cancer is suspected, determining whether the disease is localized or extends outside the capsule is important for planning treatment. Obliteration of the lateral sulcus or involvement of the seminal vesical often indicates locally advanced disease.

      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

      Neurologic examination, including determination of external anal sphincter tone, should be performed to help detect possible spinal cord compression. Findings such as paresthesias or wasting are uncommon, however.

      Digital rectal examination

      The DRE is examiner-dependent, and serial examinations over time are best. A nodule is suspicious for malignancy and warrants evaluation. In addition, findings such as asymmetry, a difference in texture, and bogginess are important clues and should be considered in conjunction with the PSA level. Change in texture over time also suggests the need for a biopsy.

      Cysts or stones cannot be accurately differentiated from cancer based on DRE findings alone. Therefore, maintain a high index of suspicion for noncancerous disorders if the DRE results are abnormal.

      If cancer is detected, the DRE findings form the basis of clinical staging of the primary tumor (ie, tumor [T] stage in the tumor-node-metastases [TNM] staging system). In current practice, most patients diagnosed with prostate cancer have normal DRE results but abnormal PSA readings.

      Previous
      Differential Diagnoses
       
       
      Media Gallery
      of 8
      Find Us On
      About
      About Medscape Privacy Policy Editorial Policy Cookies Terms of Use Advertising Policy Help Center
      Membership
      Become a Member About You Professional Information Newsletters & Alerts Market Research
      App
      Medscape
      WebMD Network
      Medscape Live Events WebMD MedicineNet eMedicineHealth RxList WebMD Corporate Medscape UK
      Editions
      English Deutsch Español Français Português UK
      All material on this website is protected by copyright, Copyright © 1994-2023 by WebMD LLC. This website also contains material copyrighted by 3rd parties.