Prosate cancer

Question 1

What type of cancers are most prostate cancers

Answer 1

Adenocarcinomas in the peripheral zone

-85% are multifocal

Question 2

Where do prostate cancers metastasize to

Answer 2

Lymph nodes, bone (sclerotic), occassionaly; lung, liver, brain

Question 3

What are the symptoms of prostate cancer

Answer 3

Mostly asymptomatic

Non specific:

• weight loss
• anorexia
• fever
• anaemia

Specific

• hypercalcaemia: anorexia, thirst, confustion, collapse
• marrow replacement: purpura, anaemia, immune suppression

Paraneoplastic

• Cushings
• Dementia

Question 4

What is the Gleason grading system

Answer 4

evaluates prognosis based on histological biopsy samples

Pattern 1 - closely resembles normal prostate tissue. glands are small, well-formed, and closely packed.

Pattern 2 - The tissue still has well-formed glands, but they are larger and have more tissue between them, stroma has increased.

Pattern 3 - The tissue still has recognizable glands, but the cells are darker. At high magnification, some of these cells have left the glands and are beginning to invade the surrounding tissue or having an infiltrative pattern.

Pattern 4 - The tissue has few recognizable glands. Many cells are invading the surrounding tissue in neoplastic clumps.

Pattern 5 - The tissue does not have any or only a few recognizable glands. There are often just sheets of cells throughout the surrounding tissue.

Question 5

Treatment for localised prostate cancer

Answer 5

Radical prosatectomy

Radiotherapy (external beam or brachytherapy)

Watchful waiting, active monitoring

Question 6

Treatment for advanced disease

Answer 6

Locally advanced

• radiotherapy
• radical prostatectomy

Metastatic disease

• surgical castration - prolonged survival,
• Androgen deprivation therapy (surgical or GNrH analogues or peripheral androgen receptor antagonists)