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Prostate Cancer: Diagnosis and Treatment
Diagnosis
- A complete history and physical examination is the initial step
in evaluating a person for prostate cancer. It should include a
digital rectal exam to evaluate the size, symmetry, and tenderness
of the prostate gland.
- Most cases of prostate cancer are detected by a blood test that
measures for prostate–specific antigen (PSA). Nearly all cases
of prostate cancer result in an elevated PSA level. However, other
disorders, such as inflammation of the prostate gland or benign
prostatic hyperplasia (BPH), can also cause PSA to be elevated.
- For a definitive diagnosis, a prostate biopsy is necessary.
- In patients with diagnosed prostate cancer, further testing will
be necessary to check for the presence of metastases. These may
include a bone scan, a CT scan of the abdomen and pelvis, and other
tests.
Treatment
Because most cases of prostate cancer grow slowly and do not become
advanced, many cases are carefully monitored but not treated. When
treatment is needed, it may include medications, radiation, chemotherapy,
or surgery.
- If prostate cancer has not spread from the prostate gland, treatments
include surgery to remove the prostate, radiation, brachytherapy
(internal radiation), and cryotherapy.
These treatments can result in significant side effects, including
urinary incontinence, impotence, and painful urination.
- In some cases, usually for advanced prostate cancer, medications
called gonadotropin–releasing hormone agonists (e.g., leuprolide)
or androgen receptor antagonists (e.g., flutamide) are used.
- Chemotherapy is sometimes used for certain types of advanced
prostate cancer.
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