Prostate Cancer: Complications

The following are the most important diseases or complications that may be contributed to by prostate carcinoma (prostate cancer):

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Hypercalcemia (calcium excess) due to tumor hypercalcemia (tumor-induced hypercalcemia, TIH).

Cardiovascular System (I00-I99).

  • Cardiovascular disease (myocardial infarction, sudden cardiac death, and apoplexy) associated with androgen deprivation therapy; risk:
    • GnRH agonists: HR value: 1.21 (95% confidence interval between 1.18 and 1.25), ie, 21% increase in relative risk If patients had experienced a cardiovascular event in the year before starting therapy: HR values 1.91 (95% confidence interval between 1.66 and 2.20), i.e., a nearly doubled cardiovascular risk!
    • Surgical castration: HR value at 1.16 (95% confidence interval between 1.08 and 1.25).
    • Antiandrogen therapy: HR: 0.87: 95% confidence interval between 0.82 and 0.91), meaning that patients had a reduced cardiovascular risk

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

Neoplasms – tumor diseases (C00-D48)

* In high-risk patients (Gleason score: 8-10 and/or PSA > 20 ng/mL), early recurrence (earyl biochemical recurrence, eBCR: two subsequent PSA tests with values > 0.2 ng/mL) occurred in 520 patients within one year in a study of a total of 1,471 patients. Men with early recurrence had a statistically increased risk, with p < 0.001, of distant metastases (33.1% versus 18.1%) and tumor-specific mortality/sterility (24.0% versus 13.1%). Psyche-Nervous System (F00-F99; G00-G99).

  • Chronic pain
  • Erectile dysfunction (ED; erectile dysfunction)Note: Patients who received early PDE-5 inhibitors (in this case, 100 mg sildenafil twice weekly, starting after bladder catheter withdrawal eight to 14 days after surgery) for penile rehabilitation after robotic-assisted prostatectomy (prostate removal) had a better chance of recovery of erectile function:
    • At 12 months, 41.4% of patients were back to preoperative IIEF-5 (“International Index of Erectile Function”) levels
    • With delayed administration of sildenafil only 17.7% of men
  • Paraplegia
  • Loss of libido

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

Injuries, poisonings, and certain other sequelae of external causes (S00-T98).

  • Fractures (broken bones)

Prognostic factors

  • In BRCA2 mutation carriers, localized prostate cancer rapidly progresses to metastatic castrate-resistant prostate cancer.
  • A high body mass index (BMI) at the time of prostate cancer diagnosis is correlated with increased prostate cancer mortality (death rate). In particular, for men with aggressive tumors, the mortality risk is significantly greater if you are overweight or obese.
  • PLCO trial (“Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial,” 13-year follow-up); biopsy (tissue sampling) in men with PSA > 4.0 ng/ml, suspicious prostate tumor, or other abnormality; died:
    • 1.1% of men died of prostate carcinoma after a negative biopsy
    • 7.2% after positive biopsy.
    • 0.4% in the control group

    For all-cause mortality (-sterility), the proportions were 18.5%, 28.3%, and 19.9%.

  • PLCO study (after 17 years): relative mortality decreased from 1.11 to 0.93 (difference from control group not significant); prostate cancer incidence increased only slightly in the screening arm, with a relative risk of 1.05 (men with Gleason score 2 to 6 are presumed to be over diagnostic).
  • Elevated serum triglyceride levels are associated with an increased risk of prostate cancer recurrence.
  • Diabetes mellitus type 2 – Prostate carcinoma (PCA) is rather rare in diabetics, but if present, the more aggressive; the tumor has significantly more androgen receptors and also expressed enzymes that degrade modulators of the estrogen receptor, thus, in aggregate, the local androgen effect is enhanced (→ growth factor in PCA).