Prostate Cancer: A Case Report

choices.

Introduction

The prostate is the part of the male reproductive system that produces seminal fluid, which is one of the components of sperm. Prostate cells can be altered in the presence of various factors and can evolve into malignancy or cancer. Currently, one man in five may be diagnosed with prostate cancer during his lifetime [1–4]. Although the 5-year survival rate is nearly 100% for stages I to III, it drops to 29% for metastatic stage IV cancers. Prostate cancer represents 24% of new cancer Cases among men, placing it as the most frequent cancer diagnosed in men after skin cancer [4]. For most cancers, many factors influence the cell susceptibility to turn or become dysfunctional or abnormal, leading to the onset of the disease. In this book, readers will learn about the prevention, screening, treatment, and follow-up procedures associated with prostate cancer, as well as the complications associated the disease. This information will be provided via the presentation of real Case reports with questions and answers from a patient diagnosed with invasive prostate cancer and its associated complications.

The signs and symptoms of prostate cancer are often linked to difficulty with urinary functions, including the frequency and urgency (i.e., pressing desire) of urination, such as an inability to perform a complete emptying of the bladder (see Case Report #1). The presence of blood in urine or sperm, painful ejaculations, and abdominal or pelvic pains are also warning signs and symptoms of prostate cancer [5] as described in the Case of our 52-year-old patient presented here. As the disease develops the above signs and symptoms become more important; and other symptoms including weight loss, tiredness, anemia, loss of bladder control, and even bone pain also occurred in our patient. With these signs and symptoms, we are more and more confident that our patient is presenting with prostate cancer and while making the main diagnosis, we should always consider the differential diagnosis that is discussed in the Case Report #2.

The main early detection and confirmation methods of prostate cancer are the digital rectal examination (DRE), the prostatic specific antigen (PSA), and the transrectal ultrasound with the fine needle prostate biopsies (see Case Report #1). Recently, new biomarkers have become available, and the information about their most recent developments as relevant to the screening, diagnosis, follow-up of disease progression, and response to treatment will be discussed in Case Report #9 and others, as applicable. Blood tests and imaging techniques are used to determine the staging of prostate cancer; that is, whether the cancer is located in the prostate only or has expanded to other organs such as the lungs, liver, bones, and lymph nodes when the diagnosis is confirmed. Biopsies are used to describe the organization of the prostate cancer (i.e., whether or not it is differentiated; see Case Report #1).

The adenocarcinomas account for 95% of prostate cancers. This type of cancer usually changes slowly, allowing for a quick treatment in the majority of Cases in order to limit the adverse effects of the disease. In general the most currently used treatments for this type of cancer are surgery, radiation therapy, hormone therapy, and of course, chemotherapy (see Case Report #3). Despite better awareness, prevention, and treatments, a 28% increase in prostate cancer Cases is predicted for 2028–32 [4].

As will be discussed in Case Report #4, there are two categories of risk factors: those that can be avoided and those that cannot. For example, in prostate cancer, factors such as age, ethnicity, genetic predispositions, and family history cannot be modified, so they are considered as internal factors [1–4].

Despite the lack of a strong causal link for the modifiable risk factors, it seems that a diet rich in flaxseed and lycopene (an antioxidant) in addition to regular physical activity would contribute to the prevention of this type of cancer [1–3]. Exposure to environmental agents such as X-rays, gamma X-rays, cadmium, and arsenic also increases the risk of prostate cancer [1–3]. This year, among the 41,000 deaths in men due to cancer, approximately 10% will be related to prostate cancer. In Case Report #4, we will discuss the main external risk factors involved in prostate cancer and the precautions that should be taken to prevent them.

The main objective of this book is to discuss strategies for the prevention and treatment of prostate cancer, as well as the adverse effects of the medication used to treat this serious health problem in order to provide patients and various partners (e.g., health care providers, nurses, medical staff, family, and others) with the tools to better prevent and manage this condition. The goal is also to present the most appropriate information that will allow patients and their families to make informed decisions, as well as to perform a benefit/risk analysis regarding the choice of their treatments. We will also discuss the paraneoplastic syndromes that are often associated with cancer. In particular, during his treatment our patient developed persistent vertigo and headaches that will be discussed in Case Report #5. In Case Report #6, we will discuss the main problem associated with his invasive prostate cancer, which is bone metastasis, and we will provide information on treatment modalities of bone metastasis.

Another important objective of this book is to provide relevant information on diet, physical activities, and stress management in order to improve the quality of life of patients suffering from prostate cancer (see Case Report #7). Although the information is presented in the form of real Case reports of a patient suffering from prostate cancer, it can also be applied to patients suffering from other forms of cancer.

Medicine is still a very limited science, and the treatment of cancer is increasingly complex. This book illustrates the importance of a better use of science in the screening, diagnosis, treatment, and follow-up of patients with prostate cancer. Regarding this, we will discuss in Case Report #8 the most promising treatment modalities for prostate cancer including: immunotherapy (checkpoint inhibitors), gene therapy, nanotechnology, vaccines, and oncolytic virotherapy. We also discuss the use of biomarkers that may better facilitate cancer screening by identifying the severity of the disease at the time of diagnosis and easing the assessment of the response to treatment (see Case Report #9).

Obviously, we cannot conclude this book without discussing the pros and cons of euthanasia and assisted suicide and the concerns raised by both patients and society as a whole on this issue (see Case Report #10). Similarly, we will discuss the role of palliative care and palliative sedation when other treatment modalities fail to control the progression of cancer and when health care providers are no longer able to manage the physical and psychological pain the patients are experiencing at the end of their lives.

This book will conclude with a discussion of cannabis, which has long been used for medicinal purposes. We will discuss the favorable outcomes associated with cannabis that include: the beneficial effects on chemotherapy-induced nausea and vomiting, as well as cancer-related psychological and physical pain. The benefits of cannabis in the treatment of anorexia, insomnia, and anxiety are also discussed. Finally, cannabinoids have shown antineoplastic effects in preclinical studies in a wide range of cancer cells and in some animal models. This will also be discussed in the Case Report #10.

Of course, compared to the last books by the same author, he will draw up a list of resources for patients and health care professionals wishing to deepen their knowledge of the topics covered in the following Case reports. By combining in a single volume the latest research as well as data from the different national and international clinical practice guidelines concerning the prevention and treatment of prostate cancer the author hopes to establish the basis of a health program to improve the prevention, treatment, and quality of life of patients with prostate cancer. The author wishes to encourage the cooperation of all partners involved in prevention and treatment activities, including universities, regulatory agencies, governments, health care professionals, national and international partners, patients, patient representatives, and the general population in the fight against prostate cancer.

References

[1] Canadian Cancer Society. What is prostate cancer? Available at: http://www.cancer.ca/en/cancer-information/cancer-type/prostate/prostate-cancer/?region=on. 2017.

[2] American Cancer Society. Key statistics for prostate cancer. Available at: https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html. 2017.

[3] Canadian Cancer Society’s Advisory Committee on Cancer Statistics. 2017. Available at: http://www.cancer.ca/en/cancer-information/cancer-101/canadian-cancer-statistics-publication/?region=bc.

[4] Public Health Agency of Canada. Health promotion and prevention of chronic disease in Canada. Res Policy Pract. 2015;35(Suppl. 1):200.

[5] Public Health Agency of Canada. What should I know about prostate cancer? http://www.phac-aspc.gc.ca/cd-mc/cancer/prostate_cancer_about-cancer_prostate_sujet-eng.php. 2017.

Chapter 1

Case Report #1—Presentation of the Patient

Abstract

This first case discusses the main signs and symptoms associated with prostate disease so that patients might identify when something is not functioning properly with their urinary system, thus a screening is required. The author discusses bone pain, which is another signal that patients should see their primary care providers immediately. The author explains screening procedures such as the digital rectal examination (DRE) and the prostatic specific antigen (PSA) to rule out the possibility of prostatitis, benign prostate hypertrophy, or prostate cancer. These differential diagnoses are discussed in this case report. The author also comments on the controversies surrounding the use of PSA as a screening and diagnostic tool. Then the author discusses the diagnostic procedure (i.e., transrectal ultrasound with prostate biopsies) that allows us to determine that the patient had a poorly differentiated prostate adenocarcinoma. With the abdominal ultrasound and the CT scan the oncologists was able to confirm that the cancer has spread to other organs (i.e., the staging). With the bone scintigraphy the oncologist was able to find the presence of bone metastasis. Unfortunately, this confirms that our patient has an aggressive form of cancer associated with a very bad prognosis. Finally, when the cancer is classified as stage IV, it has become metastatic, which is commonly known as generalized cancer as in our patient. The oncologist gives the patient a very short life expectancy, from 2 to 4 years, knowing that cancers with this stage are