FN: Prostate Cancer

Question 1

Epi

Answer 1

Commonest male Ca
3rd commonest cause of male Ca death
PrevalenceL 80% of men >80 yrs
Race: increased in blacks

Question 2

Pathology

Answer 2

Adenocarcinoma

Peripheral zone of prostate

Question 3

Presentation

Answer 3

Usually asymptomatic
Urinary: nocturia, freqeuncy, hesitancy, poor stream, terminal dribbling, obstruction
systemic: wt. loss, fatigue
Mets: bon epain

Question 4

Examination

Answer 4

Hard irregular prostate on PR

Loss of midline sulcus

Question 5

Spread

Answer 5

Local: seminal vesicles, bladder, rectum
Lymph: para-aortic nodes
Haem: slcerotic bony lesions

Question 6

Imaging

Answer 6

Bloods: PSA, U+E, acid and alk phos, Ca
Imaging:
-XR chest and psine
- TRansrectal US + biopsy
- Bone scan
- Staging MRI - contrast enhacing magnetic nanoparticles increased detection of affect nodes

Question 7

PSA

Answer 7

• Proteolytic enzyme used in liquefaction of ejaculation
• Not specific for prostate CA - raised with age, PR, TURP and prostatitis
• > 4ng/ml: 40-90% sensitivity, 60-90% specificty: only 1-in-3 will have Ca
• Normal in 30% of small cancers

Question 8

Prostate cancer grading

Answer 8

Gleason grade

Question 9

Staging

Answer 9

TNM see notes

Question 10

Prognostic factors

Answer 10

Help determine whether to pursue radical Rx
Age
Pre-Rx PSA
Tumour stage
Tumour grade

Question 11

Mx

Answer 11

• Difficult to know which tumours are indolent and will not - mortality before something else
• Radical therapy association with significant morbidity

Question 12

conservative Mx

Answer 12

Active monitoring close monitoring with DRE and PSA

Question 13

Radical therapy

Answer 13

1. Radical prostatectomy (+ goserelin if node +ve)
   - perfomred laparoscopically with robot
   - Only mproves survival vs. active monitoring if

Question 14

Medical management

Answer 14

• Used for metastatic or node + ve disease
• LHRH analogues e.g. goserelin, inhibit pituitary gonadotrophins - reduced testosterone
• Antiandrogens e..g cyproterone acetate, flutamide

Question 15

Symptomatic

Answer 15

TURP for obstruction
Analgesia
Radiotherapy for bone mets/cord compression

Question 16

Screening with PSA

Answer 16

• populatino based screening not recommened in the UK
• PSA not an accurate tumour marker
• ERSPC trial showed small mortaility benefit, PLCO trial showe dno benefit
• Must balance mortality benefit with harm caused by over diagnosis and over treatment of indolent cancers