Lecture 22 - Prostate cancer

Question 1

Location of prostate cancers

Answer 1

Peripheral zone - posterior

Question 2

Risk factors

Answer 2

Increasing age
FHx
BRCA2 gene mutation
Ethnicity - black

Question 3

Screening

Answer 3

Prostate specific antigen - liquifies semen

Not specific to prostate cancer therefore not recommended for the mass population

Question 4

Causes of raised PSA

Answer 4

Inflammation 
Infection
Larger prostate- BPH
Urinary retention - catheter 
Prostate cancer

Question 5

Issues with prostate screening

Answer 5

Over diagnosis
Over treatment - side effects e.g. urinary dysfunction
Cost -effectiveness
QoL
Can’t rely on PSA within 6 weeks of a UTI

Question 6

Presentation of prostate cancer

Answer 6

Dribbling
Pain when urinating
Haematuria
Nocturia

Question 7

Diagnosing prostate cancer

Answer 7

PSA
DRE
Histology of biopsy 
MRI of prostate 
Bone scan - common metastasise

Question 8

Grading

Answer 8

Gleason grade
- low magnification shape of cells

6 - low risk cancer
10 - high risk cancer

Question 9

Treatment for prostate cancer

Answer 9

Surveillance
Robotic radica prostatectomy - gleason grade of 10 
Radiotherapy 
- external beam
- brachytherapy - radioactive seeds 

Advanced (metastatic)
Hormones:
- decrease testosterone
- LHRH agonists
- Surgical castration
- Hormones and radiotherapy 

• chemotherapy if fit

Question 10

LHRH

Answer 10

Initially high LH and testosterone as LH normally pulsatile but given all the time

Give drugs to prevent spinal cord compression

Prostate runs out of testosterone therefore low levels of testosterone