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R a d i u m
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PATHOLOGY
Pathologically, the disease may assume three different forms: i.
As a scirrhous cancer beginning in the posterior lower segment of the
gland. In this type the disease has a tendency to follow Denonvillier's
fascia and by way of the lymph channels to invade the pelvic lymph
nodes. This is a rather malignant form of the disease, with a tendency
toward the early development of metastases. 2. A combinalion of benign
hypertrophy of the upper superior segment and malignancy of the lower
posterior part of the gland. 3. Adenocarcinoma, a less common form
of tumor, in which the entire gland is involved. This type, as a rule.
is smooth and symmetrical, but harder than the benign adenoma.
SVM1TOMS
The symptoms of cancer of the prostate are often postponed until
late in the course of the disease. This is particularly true of the type
that develops in the posterior segment of the gland and spreads upward
behind the bladder: These patients usually have no urinary symptoms,
and the pain produced by metastases is the first symptom to attract their
attention. The symptoms may be thus classified: (1) those produced
by the growth of the gland; (2^ those due to obstruction; (3) those
produced by metastases; (4) general symptoms common to malignancy.
The local symptoms arc few, such as pubic pain, pain in the perineum,
and a sensation of fullness in the rectum. The symptoms due to urinary
obstruction arc frequent, imperative urination, pain along the urethra
radiating out to the end of the penis, pyuria, and hematuria. This last
sign is often considered diagnostic of malignancy, but is not uncommonly
found in benign hypertrophy. The symptoms of metastases are pain in
the back, radiating down into the thigh, often due to pressure of enlarged
lymph nodes on the nerve roots as they come from the spine. The pain
in the back may also be caused by bone metastases. Cachexia, anemia.
loss in weight, and weakness arc the general symptoms common to all
forms of cancer.
A hard, nodular, asymmetrical, fixed or frozen gland with obliteration
of the interlobular sulcus is the description of the rectal findings
in a typical case of cancer of the prostate. However, these findings may
vary. In the early stages of the disease it may be difficult to find any
changes on the rectal side of the gland, or only a small nodule may be
palpable. The small nodules are found more readily by palpating the
gland on a sound placed in the urethra.
In the advanced cases, a hard infiltration may be felt, extending
upward above the gland and along the course of the seminal vesicles. In
the adenocarcinoma type, one may feel a large, symmetrical gland resembling
benign hypertrophy, but the consistency is much harder.
On cystoscopic examination little may be found, especially in the
type developing in the posterior segment. An elevation of the trigon
due to infiltration of this area may be the only change noted. In more
advanced cases, nodules projecting up into the bladder, at times ulcerated,
may be seen. Trabeculation and injection of the bladder wall aro found
in all cases in which retention exists.
DIAGNOSIS
The diagnosis from benign hypertrophy ordinarily is not difficult,
especially if the rectal and cystoscopic findings are at all characteristic.