Prostate cancer: diagnosis and staging
The form of the prostate cancer biomarkers can vary from Diagnosis and Classification, Used to reliably determine and distinguish the presence and type of cancer. . and invaded, as well as its effect on the organ(s) in relation to the stage. added to antipsychotics for the treatment of schizophrenia. The differential diagnosis includes: schizophreniform disorder, requires an initial CBC and frequent monitoring due to its association with agranulocytosis. Prostate Cancer Diagnosis & Management Considerations. ( Hour) Most cancers in their early, most treatable stages don't cause any symptoms.
Brain imaging may be considered for patients with concurrent neurological symptoms. Additional testing, such as electroencephalogram EEGlumbar puncture or urine copper studies, should be based on initial assessment. Immediate management of acute psychosis should focus on safety and stabilization.
Patients can be started initially on short-acting anti-psychotics. Short-acting intramuscular IM injectable formulations such as haloperidol, olanzapine, aripiprazole and ziprasidone.
Olanzapine IM mg is a good first line agent. Haloperidol IM mg is also a good initial choice, and should be given with benztropine or diphenhydramine to reduce the risk of dystonias or other extrapyramidal symptoms. Initiation of maintenance medications is often done in consultation with a psychiatrist. Most antipsychotic treatment can be initiated prior to labs. Clonazapine requires an initial CBC and frequent monitoring due to its association with agranulocytosis. Because of its risks, clonazapine is typically not a first-line agent.Prostate cancer: Essential facts
Patients with a diagnosis of schizophrenia on maintenance medication should be counseled about tobacco cessation, and offered pharmacologic therapy to assist. In addition, patients on antitypical antipsychotics should also have a fasting lipid profile and be screened for diabetes.
Cardiovascular disease is a leading cause of death for people with schizophrenia.
Schizophrenia - Cancer Therapy Advisor
This is likely due to a combination of poor preventative care, high rates of tobacco use and obesity and glucose intolerance from medication. As a result of a sedentary lifestyle and the metabolic effects of the atypical anti-psychotics, patients with schizophrenia are often obese and have impaired glucose tolerance.
There may also be a high rate of concomittent substance abuse disorders. Transitions of Care A. Sign-out considerations While Hospitalized. It should also include whether the patient is considered competent and is able to consent for medical procedures or sign-out against medical advice.
If the patient is not deemed able to consent for themselves, then the patient designated medical decision-maker or court appointed designee should also be listed on the sign-out.
Prostate Cancer Stages
Anticipated Length of Stay. One positive lymph node smaller than 2 cm across, there has been spread to the regional lymph nodes N2: More than one positive lymph node Or one that is between 2 and 5cm across N3: Distant metastasis cannot be evaluated M0: No distant metastasis M1: The TNM system is used as a standard for staging and predicting survival, choice of early treatment, and stratification of patients in clinical trials.
Knowledge of the stage of disease facilitates determining how aggressively to treat the disease and how likely the available treatment options will eliminate the disease 2.
Although it can be difficult to accurately stage the cancer, incorrect staging can result in improper treatment and substantial decrease in the patient's chance of survival Any positive cases from these tests are usually followed by biopsy and histological examination for verification. Several other tests, including X-rays, MRIs, CT scans, and bone scans, can then be used to determine the stage of cancer and to detect any localized cancers outside the prostate 2.
Despite the fact that the staging systems can reveal the extent of disease, the test results cannot be used independently to ascertain the stage of the disease, to select the best treatment options, or to envisage outcomes because they are not capable of detecting very small groups of cancer cells Therefore, in the past, efforts at screening and early detection have used all available tools for diagnosis in asymptomatic patients before the presentation of symptoms The detection and management of prostate cancer is controversial, especially regarding screening and therapy choice after diagnosis.
For example, a patient can be diagnosed late in life with a low-grade prostate cancer that may not have any impact on the quality or length of his life, while a younger man with a high-grade lesion can have an advanced disease and die within 5 years because of the disease's aggressive progression.
This intriguing observation demonstrates the unusual biological heterogeneity of prostate cancer and demands distinctive classification Nonetheless, a greater number of patients are now diagnosed at an earlier stage thanks to the advanced tools for prostate cancer diagnosis that has improved considerably in recent years.
Just as the screening and early diagnosis techniques for cervical and breast cancer have been shown to successfully reduce the death rates, respectively, from these cancers, screening for prostate cancer has successfully accomplished the same goal Despite its seemingly poor sensitivity, DRE is a routine method for prostate cancer screening because it often detects cancers missed by other tests Its main advantage is that it may detect cancer in some men with normal PSA levels and whose tumors are small and well differentiated in most cases An additional advantage of DRE is that it is a relatively inexpensive procedure that is normally well tolerated, and it can be used to investigate other abnormal conditions of the prostate, such as benign prostatic hyperplasia BPH The main limitation of DRE is that most palpable cancers are not early cancers, and many clinically important cancers are located in regions of the gland that are distant and thus evasive to digital palpation However, controversial results from two other studies revealed that there is no evidence that men who died as a result of prostate cancer were less likely to have received the screening compared to those who survived 37 Based on studies investigating the sensitivity and specificity of DRE and its role in the early detection of prostate cancer, the majority of experts agree that detection is less likely when using DRE independently as opposed to DRE in combination with other predictors Serum prostate-specific antigenPSA, discovered inis considered the most important biomarker for detecting, staging, and monitoring cancer of the prostate in its early stage 40 - PSA is a member of the family of human kallikrein proteases with a molecular mass of approximately 30 kDa and chymotryptic-like activity.
PSA was initially thought to be solely synthesized by epithelial cells of the prostate and thus was used as a biomarker for diagnosing and managing prostate cancer However, PSA has also been found in a variety of human normal and tumor cell lines and in biological fluids synthesized by numerous cells, although mainly by prostatic epithelial cells 46 PSA testing was initially used for monitoring prostate cancer patients.
After it was commercially introduced, it became extensively used for screening and diagnosing the disease. The noticeable increase in prostate cancer incidence rates in the United States, which started in the late s and peaked inis believed to be in accordance with the time period when PSA testing was introduced The main advantage of PSA testing is its superior sensitivity.
The main disadvantage of the test is that it is not very specific because common pathological conditions such as BPH and prostatitis can also cause moderately to conspicuously abnormal test results.
These false-positive results may lead to further diagnostic evaluation, increasing costs and use of more invasive procedures. Conversely, efforts to prevent such overdiagnosis that may result from the high number of false-positives may lead to delayed treatment for the aggressive, potentially life-threatening cancers In an effort to find ways of improving specificity, several variations on the basic PSA test have been proposed.
For example, the free PSA ratio, which may be a more specific test, compares the amount of free PSA circulating in the blood unbound to the amount attached to other blood proteins Furthermore, PSA levels are normally elevated in older men relative to younger men regardless of the absence or presence of cancer.
Novel diagnostic biomarkers for prostate cancer
Therefore, a continuous rise in PSA level over time from a relatively low level may be more indicative of cancer than a moderately increased PSA that is stagnant Higher PSA values have also been observed in African American men with newly diagnosed prostate cancer when compared with newly diagnosed Caucasian men Studies have shown that African American men have notably larger cancer volumes even within clinical stage category at diagnosis.
Thus, special efforts at screening are necessary to minimize the discrepancy. It may be practical, therefore, to start testing at younger ages in African American men in an effort to detect tumors earlier when they are still confined. Serum PSA value can independently predict a pathological stage. However, the serum PSA level alone may not adequately predict pathological stage because the relationship between pathological stage and serum PSA varies by tumor grade, volume, and site of origin 55 - Nevertheless, comparative studies have demonstrated that PSA and its related testing can increase the detection rate of prostate cancer in men with no symptoms 31 It has also been shown that the stage distribution of cancers detected through PSA screening was much more favorable than that which occurred in the population without PSA screening.
- Prostate cancer: diagnosis and staging
- Prostate Cancer Stages
Serum PSA testing is vital not only in screening and early detection, but it has also been found to be essential in diagnosing localized prostate cancer.