May 12, 2016 - Prostate Cancer

Question 1

What Does the Prostate Do?

Answer 1

Urinary control - muscle in prostate has gripping effect

Fertility - glands in prostate secrete fluid that helps activate sperm cells

Infection - protects bladder against infection

Question 2

Types of Prostate Cancer

Answer 2

95% adenocarcinoma

Can be small cell, transitional cell, or sarcoma

Question 3

Gleason Scoring System

Answer 3

Used to assess how aggressive a cancer is.

Ranges on a scale of 1-5

Question 4

Symptoms and Signs of Prostate Cancer

Answer 4

Early disease there are NONE

Late disease there is obstructive symptoms, hematuria, renal failure, bone pain, and abnormal DREs.

Question 5

What is PSA?

Answer 5

Prostate-specific antigen

It is a protein made by the prostate and released into semen and blood. This blood test is very accurate and it is an excellent marker to measure the activity of the prostate gland.

Used for both screening and monitoring, but does have false positives.

Question 6

Indications for Biopsy

Answer 6

Elevated PSA

Significant rise in PSA from one test to the next

Abnormal DRE

Question 7

Radical Prostatectomy

Answer 7

Surgical removal of the prostate

Hospital stay for 2-3 days and 4-6 weeks off work.

Well-tolerated, lymph nodes can be examined and sampled, and psychological relief. Also has excellent long-term results, low risk of serious complications.

Side effects and risks include erectile dysfunction (50-60%), and incontinence with stress (15-20%).

Question 8

Brachytherapy

Answer 8

Permanent insertion of radioactive seeds into the prostate gland. This focuses the radiation on the prostate gland, delivering more radiation.

Good for low and intermediate grade disease.

Quickly done and back to work quickly.

Side effects in the early stage are irritation of the bladder and urethra, and late stage can be erectile dysfunction.

Question 9

External Beam Radiation

Answer 9

High energy X-rays

Any patient with localized prostate cancer is eligible, as well as patients who are ineligible for surgery. Do NOT do in patients with IBD, previous radiation to the pelvis, or previous extensive pelvic surgery.

5 treatments per week for 8 weeks.

Side effects are fatigue of varying degrees, irritation of the lower bowel, erectile dysfunction, bladder complications, and rectal bleeding (5%).

Question 10

Cryosurgery

Answer 10

Insertion of needles into the prostate through which a cooling agent is introduced. The prostate gland is frozen, allowed to thaw, and then frozen again.

Typically good for older men. Well tolerated, 1-night stay in the hospital, and a quick return to work with minimal incontinence.

Side effects are urinary retention, swelling of scrotum and penis, discomfort with sitting, but 100% erectile dysfunction.