Adenocarcinoma Of The Prostate

Question 1

How many new diagnoses of PA each year in the uk?

Answer 1

30,000

Question 2

How many men die from PA each year in the UK?

Answer 2

10,000

Question 3

PA shows its peak incidence in which decade of life?

Answer 3

8th

Question 4

What percentage of cases present with metastatic disease?

Answer 4

20%

Question 5

What proportion of men present with PA in its early stage?

Answer 5

40%

Question 6

What are the normal presenting symptoms? (7)

Answer 6

LUTS:
Voiding: 1 poor urine flow 2 post-micturition dribbling 3 hesitancy
Storage: 4 urgency 5 nocturia 6 frequency 7 urge incontinence

Question 7

What do bone pain, pathological fractures and signs of hypercalcaemia on presentation suggest?

Answer 7

Metastatic disease

Question 8

What signs on DRE suggest malignant change?

Answer 8

Areas of firmness and palpable nodules

Question 9

Advantage of serum PSA as a screening tool?

Answer 9

High sensitivity

Question 10

Disadvantage of serum PSA as a screening tool?

Answer 10

Low specificity

Question 11

How is PSA used to investigate ?prostate adenocarcinoma? (2)

Answer 11

1 Elevated levels used in decision to biopsy 2 according to age-specific serum levels

Question 12

How is TRUS performed? (4)

Answer 12

1 rectal ultrasound probe inserted 2 ultrasound used to locate areas in prostate for biopsy 3 biopsy needle inserted through perineum into prostate to take samples 4 ABx given prophylactically due to high risk of infection

Question 13

What is the Gleason Score used for?

Answer 13

Grading PA

Question 14

What does a Gleason Score of 1+1=2 indicate? (rare)

Answer 14

Very well differentiated non-cancerous tissue

Question 15

What does a Gleason Score of 5+5=10 indicate? (2)

Answer 15

1 very poorly differentiated tissue 2 cancer likely to spread rapidly

Question 16

How is extracapsular extension and pelvic lymph node spread investigated?

Answer 16

Pelvic MRI

Question 17

When might laparoscopic node biopsy be used?

Answer 17

To sample enlarged nodes if considering radical treatment

Question 18

How are bone metastases detected?

Answer 18

Isotope bone scans

Question 19

In those with localised disease and LE <10y, what is the usual treatment plan?

Answer 19

Watchful waiting until rising serum PSA detected

Question 20

What does rising serum PSA indicate?

Answer 20

Active disease progression

Question 21

How are LUTS treated? (2)

Answer 21

1 Hormone therapy (finasteride) or 2 alpha blocker (Tamsulosin)

Question 22

Which androgen antagonist is used in this Trust?

Answer 22

Finasteride 5mg

Question 23

Which alpha blocker is used in this trust?

Answer 23

Tamsulosin 400micrograms

Question 24

Treatment for severe symptoms with features of obstruction?

Answer 24

TURP considered

Question 25

What are the features of obstruction?

Answer 25

***FILL IN LATER***

Question 26

Treatment plan when disease localised but LE >10y? (2)

Answer 26

1 Radical treatment 2 aimed at cure

Question 27

Options for curative treatment?

Answer 27

1 radical prostatectomy 2 external beam radiotherapy 3 brachytherapy

Question 28

Complications of radical prostatectomy?

Answer 28

1 severe incontinence 3% 2 ED 45%

Question 29

What dose, and how many fractions, of radiotherapy in radical treatment? (1)

Answer 29

1 55-70Gy 2 20-25 fractions

Question 30

Common complications of external beam radiotherapy? (3)

Answer 30

1 cystitis 2 proctitis 3 ED

Question 31

What is brachytherapy?

Answer 31

Radioactive seeds implanted by TRUS guidance

Question 32

Problems with TRUS guidance?

Answer 32

New technique so long-term follow up data inconclusive

Question 33

Is locally advanced PA curable?

Answer 33

No

Question 34

Treatment regime of LHRH agonists?

Answer 34

3-monthly depot injections

Question 35

Mechanism of action for LHRH agonists? (2)

Answer 35

1 Suppress testosterone production at testes 2 less androgenic drive in PA cells

Question 36

Side effects of LHRH agonists? (3)

Answer 36

1 Hot flushes 2 lethargy 3 loss of sexual function

Question 37

Mechanism of action for anti-androgens?

Answer 37

Competitive inhibition at androgen receptor

Question 38

Advantage of anti-androgens over LHRH agonists for the patient?

Answer 38

1 serum testosterone levels do not drop 2 so sexual function may be preserved

Question 39

Complications of anti-androgen therapy? (2)

Answer 39

1 gynaecomastia 2 nipple tenderness

Question 40

Treatment plan for metastatic disease?

Answer 40

1 LHRH analogues +/- anti-androgen 2 radiotherapy in cases of bone pain

Question 41

Does hormone therapy remain highly efficacious? (2)

Answer 41

1 No 2 all PA becomes hormone resistant

Question 42

When is chemo appropriate? (2)

Answer 42

1 patients with good performance status 2 with hormone-resistant disease

Question 43

How is radiotherapy used in metastatic disease?

Answer 43

Helps with bone pain (in conjunction with bisphosphonates)

Question 44

10y survival for localised PA?

Answer 44

70-90%

Question 45

Survival time in locally advanced disease?

Answer 45

7y (median)

Question 46

Prognosis for metastatic disease?

Answer 46

2-3y survival

Question 47

How prognosis changes once PA is hormone-resistant?

Answer 47

6-12month survival