Oncology

Question 1

Prostate cancer risk factors

Answer 1

Age
Family Hx
BRCA2 gene

Question 2

Clinical manifestations of prostate cancer

Answer 2

Hx: often asymptomatic, non specific urinary symptoms, haematuria, haematospermia, bone pain if metastasised, constiutional sx
DRE: assymetry, nodularity, induration of prostate

Question 3

Diagnosis

Answer 3

Transrectal core needle biopsy with imaging guidance (US/MRI)
Can track PSA over time - IF >0.75ng/mL rise over 1 year indication for biopsy (also PDA density/doubling time/MRI imaging for characterisation)
Other indications: abnormal DRE, must have good QOL

Question 4

Staging

Answer 4

TNM (T is clinical or pathological) + PSA + GLEASON SCORE

Question 5

Gleason score

Answer 5

• Used in staging of prostate cancer
• Gleason grade: grading of architectural changes on biopsy (1-5)
• Gleason composite score: sum of 2 most prevalent grades of differentiation pattern
  Grade: 1-5: correlates with a gleason composite score
  Grade 1: <=6
  Grade 2: 7 (3+4)
  Grade 3: 7 (4+3)
  Grade 4: 8
  Grade 5 : 9/10

Question 6

Treatment of prostate cancer

Answer 6

Active surveillance (very low risk, localised)

Low risk/int risk localised: radical prostatectomy, external beam radiation, brachytherapy (only by itself in low risk)

High risk, loclaised: RT+ ADT or RP

Very high risk, localised; RT +/- brachy + long term ADT

Metastatic: RT + ADT (can have RP in younger men)

Disseminated disease (stage 4): ADT, may be combined with chemo e.g. docetaxel

Question 7

Term for prostate cancer that has relapsed after initial systemic hormone replacement (+ Mx)

Answer 7

Castration resistant prostate cancer

Mx
- ADT +/- chemo + bilateral surgical orchiectomy/medical orchiectomy (GnRH agonists)

Question 8

Examples of androgen deprivation therapy

Answer 8

LHRH agonists (GnRH agonists)
Antiandrogens

Question 9

Side effects of ADT

Answer 9

Sexual • Erectile dysfunction
• Loss of libido
• Genital shrinkage

Physical • Weight gain
• Gynaecomastia
• Muscle weakness and atrophy

Metabolic • Osteoporosis
• Anaemia
• Hot flushes
• Hypertension, diabetes, heart disease,
lipid abnormalities

Emotional/cognitive • Depression
• Emotional lability

Systemic • Fatigue
• Lack of energy