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Prostate Cancer

            Prostate cancer is one of the most common forms of cancer diagnosed in men, second to skin cancer. Although causative factors are still being studied and explored, prostate cancer is thought to be dependent upon hormones, with links found between advanced age and androgens. It has been found that increased estrogen and decreased dihydrotestosterone (DHT) related to age have strong correlations with prostate cancer. It is the increase in estrogen that creates the problem, as testosterone is known to cause prostate hypertrophy but not malignancy. Other theories describe repeated injury to the prostate’s epithelium by means of carcinogens, toxins, autoimmune diseases, and inflammation. This repeated injury causes a hyper prolific state that can translate to cancer (Huether & McCance, 2017).

            Early screening is preferred because symptoms usually do not occur until advanced disease. Screening is performed by digital rectal exam and serum PSA levels. Prostate cancer will metastasize to the pelvis, bowel, lymph, rectum, and spine (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).

Treatment

            Treatment can include surgical prostatectomy, pharmacotherapy, chemotherapy, radiation, or a combination, dependent upon stage and type (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Since prostate cancer needs androgens to grow, androgen deprivation therapy (ADT) is the first line of treatment. These medications can prevent the cancer cells from receiving testosterone or reduce the amount of testosterone made altogether and ultimately slow down and/or reduce the size of the tumor. It is not a cure and many side effects can be unpleasant, including hot flashes, erectile dysfunction, osteopenia, increase in adipose tissue and weight gain (Drugs.com, 2012). Eventually, the cancer will become “castration resistant” and treatment options will need to change, mostly including novel androgen receptor targeting

agents and chemotherapy (Shiota & Eto, 2016). Patients should be educated on the need for long term treatment, medication side effects, and medication importance in order to increase compliance.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V. &  Reinhold, J. A.  (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA:  Lippincott Williams & Wilkins

Drugs.com. (2012). Prostate Cancer. Retrieved from https://www.drugs.com/mcd/prostate-cancer.

Huether, S. E., & McCance, K. L. (2017). Understanding  pathophysiology (6th ed.). St. Louis, MO: Mosby.

Shiota, M., & Eto, M. (2016). Current status of primary pharmacotherapy and future perspectives toward upfront therapy for metastatic hormone-sensitive prostate cancer. International Journal of Urology, 23(5), 360-369. doi:10.1111/iju.13091

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