Prostate cancer differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Prostate cancer must be differentiated from benign prostatic hypertrophy, renal cancer, renal stones, bladder cancer, and cystitis.
Differential diagnosis
Prostate cancer must be differentiated from:
- Benign prostatic hypertrophy (BPH)
- Renal cancer
- Renal stones
- Bladder cancer
- Cystitis
- Glomerulonephritis
- Prostatitis
- Pyelonephritis
Benign prostatic hypertrophy
- The main difference between BPH and prostate cancer is that even though the prostate gland is enlarged in both, in BPH it is a benign or noncancerous condition[1]
- BPH is very common especially as a man ages and his prostate begins to grow. When this happens, it puts pressure on the urethra resulting in the following symptoms:
- An urgent need to urinate
- Having the need to urinate many times during the day and night
- Hesitancy or troubling starting a urine flow
- Weak or dribbling urine stream
- Digital rectal exam and elevated blood test called prostate specific antigen or PSA, can confirm if it might be BPH.
- BPH does not cause prostate cancer and unlike prostate cancer, it cannot spread to other areas of the body.
Renal Cancer
- Renal cell carcinoma doesn’t usually cause any symptoms[2]
- As the disease gets more serious, you might have warning signs like:
Renal Stones
- Kidney stone usually remains symptomless until it moves into the ureter[3]
- When symptoms of kidney stones become apparent, they commonly include:
Bladder Cancer
- Bladder cancer is often painless[4]
- The most significant sign of a malignancy is urinary bleeding, either overt (known as gross hematuria) or detected with blood or imaging tests (microscopic hematuria).
- The bleeding may be consistent or intermittent.
- While blood in urine may be distressing, it is neither diagnostic of cancer nor predictive of the severity of a malignancy.
- The signs and symptoms of bladder cancer can vary based on the size and location of the tumor as well as the stage of the disease.
- In addition to bleeding, other symptoms may include:
- A persistent urge to urinate (urinary urgency)
- Frequent urination (urinary frequency)
- Back or abdominal pain
- Loss of appetite
- Unexplained weight loss
Cystitis
- Cystitis refers to an inflammation of the bladder, in most cases caused when upward moving bowel bacteria invades the bladder and begins to grow[5]
- The following are common signs and symptoms of cystitis:
- Traces of blood in the urine
- Dark, cloudy, or strong-smelling urine
- Pain just above the pubic bone, in the lower back, or in the abdomen
- Burning sensation when urinating
- Urinating frequently or feeling the need to urinate frequently
- Elderly individuals may feel weak and feverish but have none of the other symptoms.They may also present with altered mental status.
- There is a frequent need to urinate, but only small amounts of urine are passed each time.
Glomerulonephritis
- Glomerulonephritis is a disorder of glomeruli (clusters of microscopic blood vessels in the kidneys with small pores through which blood is filtered)[6]
- It is characterized by body tissue swelling (edema), high blood pressure, and the presence of red blood cells in the urine.
- Glomerulonephritis can be caused by various disorders, such as infections, an inherited genetic disorder, or autoimmune disorders.
- Diagnosis is based on tests of blood and urine and sometimes imaging tests, a biopsy of the kidneys, or both.
- People often need to restrict salt and protein intake and take diuretics or antibiotics until kidney function improves.
- Acute glomerulonephritis may appear suddenly, following a throat or skin infection.
- Symptoms include:
- puffiness of the face on waking up
- urine that is brown or contains traces of blood
- decreased urination
- fluid in the lungs leading to coughing and shortness of breath
- high blood pressure
- Chronic glomerulonephritis develops over a long time, often without obvious symptoms. However, complete kidney failure can result.
Prostatitis
- Prostatitis is a painful condition in which the prostate is inflamed, swollen, and tender. It can be caused by a bacterial infection or just simply be inflamed.[7]
- Symptoms includes:
- Pain in the perineum (the area between the rectum and the testicles)
- Pain on defecation
- Aches and pains in the joints or muscles and the lower back
- Blood in the urine
- Pain or burning during urination
- Painful ejaculation
Pyelonephritis
- Pyelonephritis denotes infection of the renal parenchyma. [8]
- Symptoms of pyelonephritis include:
- local pain (costovertebral tenderness, back or flank pain)
- systemic signs of infection (chills, fever, nausea, vomiting)
- Suprapubic discomfort or hematuria may also be reported.
- These symptoms may or may not be associated with symptoms of cystitis (dysuria, frequency, urgency, new incontinence).
References
- ↑ Chang RT, Kirby R, Challacombe BJ (April 2012). "Is there a link between BPH and prostate cancer?". Practitioner. 256 (1750): 13–6, 2. PMID 22792684.
- ↑ Barocas DA, Rabbani F, Scherr DS, Vaughan ED (January 2006). "A population-based study of renal cell carcinoma and prostate cancer in the same patients". BJU Int. 97 (1): 33–6. doi:10.1111/j.1464-410X.2005.05880.x. PMID 16336324.
- ↑ Chung SD, Liu SP, Lin HC (2013). "Association between prostate cancer and urinary calculi: a population-based study". PLoS ONE. 8 (2): e57743. doi:10.1371/journal.pone.0057743. PMC 3581486. PMID 23451265.
- ↑ Rom M, Kuehhas FE, Djavan B (2007). "New findings in bladder and prostate cancer: highlights of the 22nd annual congress of the European association of urology, march 21-24, 2007, berlin, Germany". Rev Urol. 9 (4): 214–9. PMC 2199502. PMID 18231618.
- ↑ Fan CY, Huang WY, Lin KT, Lin CS, Chao HL, Yang JF, Lin CL, Kao CH (2017). "Lower Urinary Tract Infection and Subsequent Risk of Prostate Cancer: A Nationwide Population-Based Cohort Study". PLoS ONE. 12 (1): e0168254. doi:10.1371/journal.pone.0168254. PMC 5207623. PMID 28046120.
- ↑ Heaf JG, Hansen A, Laier GH (February 2018). "Quantification of cancer risk in glomerulonephritis". BMC Nephrol. 19 (1): 27. doi:10.1186/s12882-018-0828-2. PMC 5797419. PMID 29394927.
- ↑ Rybicki BA, Kryvenko ON, Wang Y, Jankowski M, Trudeau S, Chitale DA, Gupta NS, Rundle A, Tang D (June 2016). "Racial differences in the relationship between clinical prostatitis, presence of inflammation in benign prostate and subsequent risk of prostate cancer". Prostate Cancer Prostatic Dis. 19 (2): 145–50. doi:10.1038/pcan.2015.54. PMC 4865439. PMID 26620738.
- ↑ Doat S, Marous M, Rebillard X, Trétarre B, Lamy PJ, Soares P, Delbos O, Thuret R, Segui B, Cénée S, Menegaux F (April 2018). "Prostatitis, other genitourinary infections and prostate cancer risk: Influence of non-steroidal anti-inflammatory drugs? Results from the EPICAP study". Int. J. Cancer. doi:10.1002/ijc.31565. PMID 29696626.