There is poor urinary stream, haematuria, back or leg pain, as well as urinary urgency. Other features of secondary spread may also be present. Digital rectal examination typically reveals an irregular, firm prostate or nodule.
- Measurement of PSA levels either total or ratio of free to bound.
- Biopsy for histology; Gleason score suggestive of prognostic outcome.
- Catheterize those with acute retention. If this fails, revert to a suprapubic cystostomy.
- Initiate other emergency treatment as needed.
- Initiate hormonal therapy for advanced disease. Either orchidectomy (surgical) or stilboesterol 1mg 8 hourly or LHRH analoges leuproreline (slow release) 3.75mg subcutaneous of IM, monthly.
- Administer antibiotics for infection according to culture reports. Start on nitrofurantoin 100mg 6 hourly and await cultures.
- Provide nutritional support.
- Assess renal function.