Upon further examination and review of H.C.’s chart, our team determined that H.C. has prostate cancer.
Prostate cancer does not present symptoms until it is in advanced stages. H.C.’s first manifestation was dsyuria and incomplete emptying of his bladder. The culmination of these symptoms was fatigue due to the frequency of being awoken when sleeping. Although dysuria also presents as a symptom of Benign Prostate Hypertrophy, H.C. also presented with abdominal pain. The conjunction of fatigue and abdominal pain, not typically present in Benign Prostate Hypertrophy, required further assessment of any metastasis to surrounding lymph nodes and the liver (McCance & Huether, 2019).
Screening for prostate cancer begins routinely with a digital rectal exam (DRE) and a prostate-specific antigen blood test—both of which are traditionally administered yearly to allow for early detection. Both exams were particularly important in H.C.’s case due to his African American descent and the elevated presence of prostate cancer in the African American culture. The importance of these yearly exams was elevated further with H.C’s history of cancer and germ-line risk. H.C.’s PSA of 7.2 μg/L correlates with an increased concern prostate cancer as the likely differential. Our team then conducted the DRE of H.C. This practitioner inserted his finger into H.C.’s rectum and felt H.C.’s enlarged prostate. While DRE’s may detect early prostatic carcinomas, DRE’s have low-sensitivity and specificity. As such, our team confirmed H.C.’s diagnosis of prostate cancer with a tissue biopsy. With the benefit of new, innovative screening technology, practitioners were also able to determine the stage of metastasis to lymph, bone, and other adjacent tissues.
H.C. matched several, known risk factors for this disease including: his age (72); his African American descent; and his familial history of cancer. H.C. also matched a currently-unconfirmed risk factor by his likely exposure to Agent Orange and his surgical vasectomy (McCance & Huether, 2019). Currently, the correlation of increased risk of prostate cancer and Agent Orange exposure is debatable, however, current studies indicate that this factor should also be considered as a risk for future prostate cancer diagnoses. Additionally, although it was historically thought that a vasectomy can place a male at increased risk of prostate cancer, the most current research no longer shows a strong correlation (McCance & Huether, 2019).