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Introduction
  • Most common cancer in men
    • second most common cause of cancer death
  • DHT dependent hyperplasia
    • arises from the posterior lobe (peripheral zone)
      • BPH arises from periurethral zone
      • unlike BPH, no obstructive uropathy until invasion of bladder neck
  • Risk factors
    • ↑ age (most important)
    • family history
    • African-American race
    • smoking
Presentation
  • Physical exam
    • digital rectal examination reveals a hard nodule
    • lower back pain 
      • indicates bone metastasis
Evaluation
  • Serology
    • prostatic acid phosphatase (PAP) and PSA
      • sensitive but not specific
        • elevated in prostatitis and BPH
      • ↑ total PSA (> 10 ng/mL)
      • fraction of free PSA and PSA velocity
    • ↑ serum alkaline phosphatase 
      • indicates bone metastasis
  • Biopsy
    • only perform if nodule palpated, ↑ total PSA
Treatment
  • Surgical
    • prostatectomy + radiation (early disease)
  • Medical
    • hormonal therapy + chemo (late disease)
Prognosis, Prevention, and Complications
  • Metastasis
    • bone
      • most commonly spine, femur, and pelvis
      • spread hematogenously via Batson venous plexus
      • can also spread lymphatically to paraaortic nodes then to bone
    • lungs
    • liver
 

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