The cancer diagnosis is too late. What should this patient do differently to detect the prostate cancer in earlier stage?

I'm so sorry to hear that the cancer diagnosis was made at a late stage. Detecting prostate cancer early is crucial for effective treatment and improved outcomes. To detect prostate cancer at an earlier stage, I would recommend the following:

1. **Regular Prostate-Specific Antigen (PSA) testing**: The American Urological Association (AUA) recommends that men between 55 and 69 years old discuss the benefits and risks of PSA testing with their doctor. If the patient had a family history of prostate cancer or was of African American descent, they may need to start testing earlier, around age 40-45.
2. **Digital Rectal Exam (DRE)**: A DRE is a simple, non-invasive exam where a doctor inserts a gloved finger into the rectum to feel the prostate gland for any abnormalities. This exam can help detect prostate cancer, especially in areas where the cancer may not be producing much PSA.
3. **Know the risk factors**: Certain risk factors increase the likelihood of developing prostate cancer, such as:
* Family history (father, brother, or son with prostate cancer)
* African American descent
* Age (risk increases after 50)
* Obesity
* High-fat diet
* Sedentary lifestyle
4. **Maintain a healthy lifestyle**: A balanced diet rich in fruits, vegetables, and whole grains, along with regular exercise and a healthy weight, may help reduce the risk of prostate cancer.
5. **Be aware of symptoms**: Although early prostate cancer often doesn't cause symptoms, being aware of potential warning signs can lead to earlier detection. These may include:
* Difficulty starting or stopping urination
* Weak or interrupted flow of urine
* Frequent urination, especially at night
* Painful or burning urination
* Difficulty getting an erection
* Painful ejaculation
6. **Genetic testing**: If the patient has a strong family history of prostate cancer, they may want to consider genetic testing to identify inherited genetic mutations that increase their risk.
7. **Participate in screening programs**: Many organizations, such as the Prostate Cancer Foundation, offer free or low-cost screening programs for men at high risk or without access to regular healthcare.

It's essential to note that not all prostate cancers are aggressive, and some may not require immediate treatment. However, by following these recommendations, the patient may have been able to detect the cancer at an earlier stage, when treatment options are more effective.

In the future, researchers are exploring new biomarkers and tests, such as the Prostate Health Index (PHI) and the 4Kscore, which may help improve early detection and reduce unnecessary biopsies. Additionally, there is ongoing research into the use of MRI and other imaging modalities for prostate cancer screening.

I hope this information is helpful. If you have any further questions or concerns, please don't hesitate to ask.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.
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In June 2022, due to the worsening of his visual and neurological deficits, he underwent a new CT scan, which revealed an increase in the size and edema of the lesion.
Due to clinical and imaging deterioration, the patient underwent a left fronto-temporo-orbital craniotomy the following week.

In July 2022, he underwent a control CT scan, which showed practically complete regression of the cerebral edema.
The immunohistochemical profile revealed cancer cells with large expression of CK8/18 and AE1/AE3, focal expression of epithelial membrane antigen (EMA), and no expression of CK7, TTF-1, SSTR-2a, P63, CK5/6, S100 protein, or MELAN-A. The Ki-67 proliferation index was 30%.

The CT TAP revealed, as relevant alterations, signs of left frontotemporal craniotomy with a persisting collection of heterogeneous content, but with gas bubbles in the left retro-orbital region with peripheral contrast uptake that is probably related to inflammatory alterations; multiple punctate pulmonary micronodules with some of high-density that may only be residual, the rest being non-specific; the presence of two tiny millimetric hypodensities in the liver up to 3 mm: one in the caudate lobe and the other on the periphery of segment IV, which is too small for proper characterization but could correspond to small cysts; prostate and seminal vesicles were totally inconclusive, requiring further investigation; and, finally, there were signs of diffuse bone metastasization with multiple bone metastases of a blastic predominance, although with some lytic images, particularly in the left iliac bone adjacent to the prosthesis, which could also be metastatic.

It is important to note that, at this stage, the patient had gait impairment due to pain that started two weeks before. The analytical study revealed increasing PSA values, rising from 3.17 ng/mL at the end of January (around two months before he started complaining of left eyelid edema) to 91.4 ng/mL at the beginning of August.

Based on the patient's symptoms, imaging findings, and laboratory results, I predict the top 2 disease causes as:

1. **Metastatic Prostate Cancer**: The patient's increasing PSA values, bone metastases, and prostate and seminal vesicles abnormalities on CT scan suggest prostate cancer as the primary malignancy. The presence of CK8/18 and AE1/AE3 expression in the tumor cells also supports this diagnosis.
2. **Brain Metastasis from Prostate Cancer**: The patient's neurological deficits, visual impairment, and cerebral edema on CT scan, which improved after craniotomy, suggest brain metastasis. The immunohistochemical profile and Ki-67 proliferation index of 30% also support this diagnosis.

These two diagnoses are closely related, as prostate cancer is known to metastasize to the brain, bones, and other organs. Further investigation, including prostate biopsy and molecular testing, would be necessary to confirm these diagnoses.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.
##

In June 2022, due to the worsening of his visual and neurological deficits, he underwent a new CT scan, which revealed an increase in the size and edema of the lesion.
Due to clinical and imaging deterioration, the patient underwent a left fronto-temporo-orbital craniotomy the following week.

In July 2022, he underwent a control CT scan, which showed practically complete regression of the cerebral edema.
The immunohistochemical profile revealed cancer cells with large expression of CK8/18 and AE1/AE3, focal expression of epithelial membrane antigen (EMA), and no expression of CK7, TTF-1, SSTR-2a, P63, CK5/6, S100 protein, or MELAN-A. The Ki-67 proliferation index was 30%.

The CT TAP revealed, as relevant alterations, signs of left frontotemporal craniotomy with a persisting collection of heterogeneous content, but with gas bubbles in the left retro-orbital region with peripheral contrast uptake that is probably related to inflammatory alterations; multiple punctate pulmonary micronodules with some of high-density that may only be residual, the rest being non-specific; the presence of two tiny millimetric hypodensities in the liver up to 3 mm: one in the caudate lobe and the other on the periphery of segment IV, which is too small for proper characterization but could correspond to small cysts; prostate and seminal vesicles were totally inconclusive, requiring further investigation; and, finally, there were signs of diffuse bone metastasization with multiple bone metastases of a blastic predominance, although with some lytic images, particularly in the left iliac bone adjacent to the prosthesis, which could also be metastatic.

Based on the provided information, I predict the top 2 disease causes for this patient case to be:

1. **Metastatic Carcinoma**: The presence of diffuse bone metastasization, multiple bone metastases, and a high Ki-67 proliferation index (30%) suggest a malignant tumor. The immunohistochemical profile reveals cancer cells with large expression of CK8/18 and AE1/AE3, which are markers commonly associated with carcinomas.
2. **Glioblastoma**: The patient's worsening visual and neurological deficits, along with the increase in size and edema of the lesion on CT scan, suggest a primary brain tumor. The immunohistochemical profile does not rule out glioblastoma, and the presence of a high Ki-67 proliferation index is consistent with this diagnosis.

Please note that these predictions are based on limited information and may not be definitive without further diagnostic testing and evaluation.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.
In addition, to detect any cancer risk early, what screening tests should this patient do?
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The patient is a Caucasian, 62-year-old male, and was the head of the finance department of a company. He belonged to an extended family (stage VII of the Duvall family lifecycle) and was of medium-high socioeconomic class, according to the adapted Graffar Scale. His personal medical history included dyslipidemia, overweight (BMI 30.3 kg/m2), and atrial flutter, for which he underwent ablation in 2019. His prostate cancer screening didn't reveal any alteration, with stable prostate-specific antigen (PSA) values of around 2 ng/mL since 2013. Surgical history included the placement of a left hip prosthesis in 2009, a tonsillectomy more than 30 years ago, and the removal of a vocal cord polyp. He also had a drinking habit (10 drinks a day) and a history of smoking, with a smoking load of 75 pack years, and has been abstinent since 2019. His daily medication included metoprolol, rosuvastatin, omeprazole, and furosemide. His family history included a daughter with Hodgkin's lymphoma diagnosed at the age of 12 and the death of his mother at the age of 74 from nasopharyngeal cancer.

In March 2022, he consulted an ophthalmologist for left eyelid swelling and was treated with topical corticosteroids.

In April 2022, he consulted his family doctor due to a sudden onset of confusion and dysarthria earlier that day, lasting one minute and with spontaneous resolution, but with amnesia about what had happened, according to his daughter's statement. Upon objective examination, only the presence of slight exophthalmos and left eyelid ptosis stood out, with no other noticeable deficits found during the neurological examination.

Given this situation, the patient was referred to the emergency room, where he underwent a cranial-encephalic CT scan that revealed a left anterior temporal lesion with adjacent edema, compatible with meningioma, which was later confirmed on an MRI. The diagnostic hypothesis was episodic motor dysphasia in the context of focal crisis and left temporal meningioma. He was treated with antiepileptic drugs and corticosteroids.

Based on the patient's medical history and symptoms, I predict the top 2 disease causes as:

1. **Meningioma**: The patient's symptoms of confusion, dysarthria, and amnesia, along with the imaging findings of a left anterior temporal lesion with adjacent edema, are consistent with a meningioma. Meningiomas are typically slow-growing tumors that can cause seizures, cognitive impairment, and focal neurological deficits.
2. **Cerebrovascular disease**: The patient's history of atrial flutter, hypertension, and smoking increases his risk for cerebrovascular disease. The sudden onset of confusion and dysarthria could be indicative of a transient ischemic attack (TIA) or stroke, although the imaging findings suggest a meningioma.

To detect any cancer risk early, I recommend the following screening tests:

1. **Low-dose computed tomography (LDCT) scan**: Given the patient's smoking history, an annual LDCT scan is recommended to screen for lung cancer.
2. **Colonoscopy**: As the patient is 62 years old, a colonoscopy is recommended to screen for colorectal cancer, as per the American Cancer Society guidelines.

Note: The patient's prostate cancer screening is up-to-date, and his PSA values have been stable since 2013, so no additional screening is recommended for prostate cancer at this time.