MensHealth_10_10_14

Question 1

What is the most common male cancer? How many men are diagnosed with it in the UK each year?

Answer 1

Prostate cancer. 40,000 men a year are diagnosed.

Question 2

What is the lifetime risk of a man developing prostate cancer?

Answer 2

1 in 8.

Question 3

Which age group has the peak incidence of prostate cancer?

Answer 3

75-79yrs old.

Question 4

Are any ethnic groups more or less limey to develop prostate cancer?

Answer 4

Black African and black Caribbean men are 3x more likely to develop prostate cancer in the UK, and on average are 3-5 years younger at presentation. Asian men have a lower risk compared to other groups.

Question 5

Does family Hx affect chance of prostate cancer?

Answer 5

Yes. First degree relative with prostate cancer more than doubles the risk; 2 or more 1st degree relatives quadruples the risk.Interestingly, a Fx of breast Ca also increases the risk. A faulty BRACA2 gene is one possible link.

Question 6

What foods decrease the risk of prostate cancer?

Answer 6

Tomatoes (they contain lycopene) and brazil nuts and sea food (contain selenium).

Question 7

How is prostate cancer staged?

Answer 7

Prognosis is closely related to staging and classification.Stages 1 and 2 - localised cancerStage 3 - locally advanced (spread beyond the gland capsule)Stage 4 - represents metastatic disease

Question 8

What grading system is used for prostate cancer? How does it work? What can the score be, and what do the numbers mean?

Answer 8

The Gleason score grades the aggressiveness of the cancer on a scale between 6 and 10 and is based on the histopathology in the biopsy.The Primary Gleason grade has to be greater than 50% of the total pattern seen (i.e. the pattern of the majority of the cancer observed)The Secondary Gleason grade has to be less than 50%, but at least 5% of the pattern of the total cancer observedThese summation of these two grades produces the Gleason scoreA Gleason score of 6 is considered a low grade, 7 intermediate grade, while scores of 8-10 are aggressive high grade tumours.

Question 9

When might radical prostatectomy be used as Rx for prostate cancer?

Answer 9

If the disease is localised; patients may need f/u by GP for e.g., erectile dysfunction.

Question 10

What treatments re used for more advanced prostate cancer?

Answer 10

Hormonal therapies such as goserelin, TURP, radical prostatectomy, radiotherapy and/or chemotherapy are used for more aggressive/advanced disease. There is ongoing uncertainty about the best treatment for low grade and early stage disease.

Question 11

What is the five year survival rate for prostate cancer?

Answer 11

90% for stage 1 or 2.30% for stage 4.Overall, regardless of stage or grade, the average five year survival rate is 81%.

Question 12

When might watchful waiting be appropriate for prostate cancer? What does it involve?

Answer 12

Watchful waiting may be appropriate for any disease stage and Gleason score; it involves PSA monitoring and active surveillance. For men with low grade and tumour volume repeat biopsies may also be taken.

Question 13

What are lower urinary tract symptoms? (LUTS)(There are 6; name 4 at least)

Answer 13

FrequencyNocturiaUrgencyHesitancyTerminal dribblingWeak or intermittent stream

Question 14

Why may prostate cancer not initially have obvious symptoms?

Answer 14

Localised prostate cancer may not have obvious symptoms or signs because it usually originates in the outer part of the prostate gland away from the urethra. Even locally advanced cancers are may be asymptomatic, although the tumour may be palpable on digital rectal examination (DRE).

Question 15

What symptoms usually prompts Ix and diagnosis of prostate Ca? What other common condition causes the same symptoms?

Answer 15

Lower urinary tract symptoms.Benign prostatic hypertrophy causes the same symptoms

Question 16

What are symptoms of locally invasive prostate Ca?

Answer 16

HaematuriaHaematospermiaErectile dysfunctionUrinary tract infection

Question 17

What are symptoms of metastatic prostate Ca?

Answer 17

FatigueAnaemiaBone painWeight loss

Question 18

On digital rectal exam, what are the signs that may indicate possible prostate cancer?(there are 5 - name them all!)

Answer 18

HardnessTendernessIrregularity or nodulesImmobility (tethering to adjacent tissue)Enlargement (although smooth enlargement is suggestive of BPE rather than prostate cancer)

Question 19

Is PSA testing ever indicated in asymptomatic men?

Answer 19

Only if they are older than 50 and have had full counselling.

Question 20

What are the benefits of the PSA test?(Name 2)

Answer 20

1) It may help pick up a more aggressive cancer at an early stage when treatment may prevent the cancer from becoming more advanced2) Regular PSA tests could be helpful for men who have a higher risk of developing prostate cancer, but we need more evidence about the best way of doing this.

Question 21

What are the limitations of the PSA test?(Name 4)

Answer 21

1) The PSA test cannot distinguish low and high grade tumours2) Prostate cancer treatment can have life changing side effects, including infertility and reduced libido3) A raised PSA may need to be followed up with a transrectal ultrasound (TRUS) guided biopsy. This is an uncomfortable procedure which carries a risk of complications, such as infection and bleeding4) It is neither sensitive nor specific and will not detect all cancers. Around two thirds of men with a raised PSA will not have cancer. High PSA levels are found in several non-malignant prostate conditions including benign prostate hypertrophy (BPH) and prostatitis.

Question 22

What should men NOT do before having a PSA test?(Name 5)

Answer 22

1) Ejaculate in the previous 48 hours2) Exercise vigorously in the previous 48 hours3) Have a prostate biopsy in the previous six weeks4) Have an active urinary infection (PSA may remain raised for many months)5) It is advisable to do a PSA test before a DRE.

Question 23

How does PSA referral levels vary with age? What other factors should be considered before referring?

Answer 23

Age PSA referral value (mg/ml)50-59 ≥ 3.060-69 ≥ 4.070 and over > 5.0BUT also take into account symptoms, ethnicity, Fx, DRE findings, etc.

Question 24

Is there a screening test for prostate Ca?

Answer 24

No! PSA is rubbish for screening for prostate Ca!BUT…there is a lot of research into finding a better test.These include the urine prostate cancer antigen 3 (PCA3) obtained from a post-DRE urine sample and a range of other biomarkers and genetic screening tests. Although none of these are yet available routinely on the NHS, evidence is emerging that combined analysis of a selected range of these tests including PSA may yield better sensitivity and specificity for prostate cancer than by using PSA alone.