Disease Description (Causes and Symptoms)
- Definition and pathophysiology: The prostate is a male reproductive organ located directly below the bladder. Prostate-specific antigen (PSA), which is secreted by the prostatic epithelium, is present in the blood. Prostate cancer usually begins as malignant proliferation of epithelial cells that grow primarily in response to androgens (male hormones), with a tendency to invade locally and then metastasize to the lymph nodes and bones. Because of its anatomical location surrounding the urethra, it can cause urinary symptoms even when relatively small.
- Main causes and risk factors: The exact cause is unknown, but it is associated with advanced age, African ancestry, family history (genetic predisposition), obesity, and a high-fat diet (particularly animal fats).
- Main symptoms:
- Urinary problems: difficulty urinating, frequent urination, sensation of incomplete bladder emptying, nocturia, urinary urgency, acute urinary retention (inability to urinate at all)
- Hematuria (when the bladder is invaded)
- Hydronephrosis and back or lower back pain caused by ureteral obstruction
- When metastasized: localized pain due to bone metastases, risk of fractures, swollen lymph nodes, anemia, and systemic symptoms
Treatment Methods
(The treatment plan varies depending on the stage (localized, locally advanced, or metastatic), Gleason score/Grade group, PSA level, and the patient's age and general health.)
- Localized disease (low to intermediate risk)
- Active surveillance: monitoring the course in low-risk groups through regular PSA testing, digital rectal examinations, imaging, and repeat biopsies
- Surgical treatment: radical prostatectomy (open, laparoscopic, or robot-assisted), with pelvic lymph node dissection if necessary
- Radiation therapy: external-beam radiation (stereotactic or intensity-modulated radiation therapy), and brachytherapy
- Locally advanced/high-risk disease
- Surgery or radiation plus androgen deprivation (hormone therapy; adjuvant treatment)
- Metastatic prostate cancer
- Androgen deprivation therapy (ADT): LHRH agonists/antagonists, surgical castration (orchiectomy), and combination therapy with antiandrogens
- Additional systemic treatment: in some cases, combination treatment with chemotherapy (docetaxel) or novel androgen receptor-targeted agents (such as abiraterone and enzalutamide) is recommended in the setting of initial metastatic disease
- Castration-resistant prostate cancer: additional anticancer drugs (such as cabazitaxel), radium-223 (in some cases of symptomatic bone metastases), and targeted radioligand therapy such as Lutetium-177-PSMA, depending on the indication
- Management of bone metastases
- Skeletal protective agents: zoledronic acid (a bisphosphonate) and denosumab (an inhibitor of bone resorption)
- Local radiation (to relieve bone pain) and orthopedic treatment (when there is a risk of pathological fracture)
- Symptom relief and supportive care
- Management of urinary incontinence and erectile dysfunction (rehabilitation, medication, and surgical assistance)
- Management of hormone therapy side effects (bone density, metabolic syndrome, and cardiovascular risk management)
- Side effects and precautions
- Surgery: urinary incontinence, impaired sexual function (erectile dysfunction), and surgical complications
- Radiation: bladder and rectal irritation symptoms, and impaired sexual function
- ADT: hot flashes, decreased libido, muscle loss and osteoporosis, and increased metabolic and cardiovascular risks
- Chemotherapy: bone marrow suppression, vomiting, hair loss, and others
- Follow-up: regular PSA testing after treatment (monitoring trends), with imaging tests when necessary
Checkpoints Before an Outpatient Visit (Including Items to Bring, Records, and Sample Questions)
- Recommended items to bring
- Recent blood PSA levels and test dates (and past trends if possible)
- Prostate biopsy results (pathology report; Gleason score/Grade group)
- Recent imaging results: prostate MRI, abdominal/pelvic CT, or bone scan/PSMA-PET results
- List of current medications (including hormone medications and anticoagulants), and allergy history
- Previous surgeries and major medical history (such as cardiovascular disease and diabetes)
- Records of changes in urinary symptoms (frequency, sensation of incomplete emptying, episodes of acute urinary retention), and the location and intensity of pain
- Items that can be measured directly during the outpatient visit
- Urine (whether hematuria is present), whether a digital rectal examination (DRE) was performed, body weight, and blood pressure
- Sample questions (items to ask directly during the appointment)
- What is my recent PSA level and its trend over time?
- What does my stage mean (in terms of Gleason score, PSA, and imaging findings)?
- What treatment options do you recommend for me, and what are the expected benefits and side effects of each?
General Sample Questions to Ask the Doctor
- What are the recommended treatment options for this stage, and what are the advantages and disadvantages of each?
- How will treatment affect my sexual function, urinary function, and quality of life? What is the likelihood of recovery?
- What are the common side effects of hormone therapy, and how can they be prevented and managed?
- After treatment, which follow-up tests are needed, and how often should they be performed?
- If there are bone metastases, how will pain be managed, and when should bone-strengthening agents be used and what are their side effects?
Disease-Specific Sample Questions
- Considering my recent PSA level (e.g., 10 ng/mL) and Gleason score (e.g., 3+4=7), is active surveillance possible, or would you recommend surgery or radiation therapy?
- Bone metastases have been confirmed (specific sites: pelvis/lumbar spine). What combination of treatments (local radiation, radium-223, zoledronic acid/denosumab) is recommended to relieve pain and prevent fractures?
If you need any additional materials (such as a summary for a medical certificate, interpretation of test findings, or a comparison table of treatment options), please let us know, and we will organize them in a customized format.