2804NRS Assessment 2: In-depth Case Study Analysis of Prostate Cancer

This case study presents an analysis of a 68-year-old African-American male, Ahmed, diagnosed with stage four prostate cancer. The discussion explores the links between Ahmed’s risk factors, including age, race, and family history of prostate cancer, and the disease's etiology, particularly the BRCA1 gene mutation. It further examines the pathophysiology manifestations, such as urinary symptoms, pelvic pain, and weight loss, justifying the recommended diagnostic tools like ultrasound and MRI fusion, as well as treatment modalities including hormone therapy and chemotherapy aimed at managing the condition and improving the patient's quality of life. The analysis references various studies to support the discussion on risk factors, diagnostic approaches, and treatment options for advanced prostate cancer.

Case Study Discussion and Analysis
The patient is a 68 years old male who is suffering from prostate cancer with an enlarged
nodular asymmetrical prostate. The aim of this discussion is to describe the link between
Ahmed’s risk factors and aetiology related to the disease. The discussion will further consider
the pathophysiology manifestations of prostate cancer, while justifying the recommended
diagnostic tools and treatment modalities.
Links between Patient’s Risk Factors and Aetiology
As reflected in several researches, age is a major risk factor for the occurrence of prostate
cancer. Other risk factors include dietary habits, lifestyle, race, genetic factors, and family
history (Morigi et al., 2015). Considering the case of Ahmed, he is an African-American and
68 years old. In addition, he stated that 30 years ago his father died from prostate cancer.
These factors have created major risks for Ahmed considering his age, race, and genetic
factors. He is suffering from stage four malignant prostate mainly due to the mutation faced
by the BRCA1 gene. Irrespective of many risk factors involved, there is no exact
acknowledgment for what ends up causing prostate cancer (Taylor et al., 2010). Several
factors might have developed the condition for Ahmed such as his age, his family history,
and his race.
Pathophysiology Manifestations
In majority of the cases, the symptoms of prostate cancer do not become evident during the
initial stages of the disease. There are different symptoms of cancer for different men and any
of the symptoms may occur due to other conditions (Sylvester et al., 2007). Specifically,
there are urinary symptoms of the disease. Due to the close distance of prostate gland to
urethra and bladder, there can be accompany of prostate cancer by a number of urinary
symptoms. Being highly dependent on the location and the size, a tumour may possibly

pressurize and constrict the urethra that inhibits the urine flow. Some signs of prostate cancer
in context with urination are as follows (Bill-Axelson et al., 2014):
 Blood consisting of urine
 Decreased velocity or flow or urine stream
 Loss in the control of bladder
 More frequent feeling of urination during night
 Difficulty in urination
 Pain or burning feel while urinating
Prostate cancer has the ability of spreading across closer bones or tissues. If there is spreading
of cancer across the spine, it is strongly pressed upon the spinal nerves (Baade et al., 2009).
Other symptoms of prostate cancer is inclusive of additional bone, pain or numbness in the
feet, legs, or hips, swelling in pelvic area or legs, pain during ejaculation, difficulty to gain
erection, and blood in semen (Heidenreich et al., 2014b). As in the case of Ahmed, he has
been dealing with pelvic pain and consistent weight loss since the last two months. He has to
urinate at least five times during the night and on occasional basis, urine consists of blood. He
complains about facing weak urine streams since a number of years.
Justification of Diagnostic Tests and Treatment Modalities
After the performance of digital rectal examination, an enlarged nodular, asymmetrical
prostate was found and hence, there was requirement for further tests. The following
diagnostic tests can be recommended in the case of Ahmed.
Ultrasound: In case of raising concerns in other tests, there can be utilization of trans-rectal
ultrasound for further evaluation of the prostate. This utilizes sound waves for obtaining view
of the prostate gland (Klotz et al., 2014).

Collection of prostate tissue as a sample: This considers the conduct of prostate biopsy
involving the analysis of tissue sample for determining the presence of cancer cells.
MRI Fusion: This is helpful for the conduct of prostate biopsy and further diagnosis (Kwon et
al., 2014). There is a collaboration between radiologists and urologists for leveraging the
technology of MRI fusion biopsy to yield the best imaging for caring for prostate cancer.
Further ahead, it is necessary to determine the aggressive or passive nature of prostate cancer.
The scale commonly used for the evaluation of cancer aggressiveness is known as Gleason
Score. This involves the combination of two numbers while ranging between 2 and 10.
The treatment of prostate cancer involves surgery for the removal of prostate gland that is
known as radical prostatectomy. This involves the removal of some lymph nodes and
surrounding tissue (Taylor et al., 2010). However, Ahmed is at stage 4 prostate cancer. There
is no cure for stage 4 cancer but it can be treated with the objective of controlling the cancer
as much as possible and improving the quality of life. The following treatment options are
available for preventing or relieving symptoms like pain: hormone therapy with
chemotherapy, external beam radiation, radical prostatectomy, surgery for symptoms like
urinary obstruction or bleeding, active surveillance, and clinical trial for new treatments
(Heidenreich et al., 2014a). Ahmed’ cancer can only be avoided not cured.

References
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Bill-Axelson, A., Holmberg, L., Garmo, H., Rider, J. R., Taari, K., Busch, C., ... & Andrén,
O. (2014). Radical prostatectomy or watchful waiting in early prostate cancer. New England
Journal of Medicine, 370(10), 932-942.
Heidenreich, A., Bastian, P. J., Bellmunt, J., Bolla, M., Joniau, S., van der Kwast, T., ... &
Mottet, N. (2014a). EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local
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