Prostate

Question 1

Outline the histology of prostate Ca

Answer 1

Adenocarcinoma peripheral zone (localized, local advanced, mets)

Question 2

What is the 2WW referral criteria for suspected prostate Ca?

Answer 2

DRE - craggy

Raised PSA - with not other cause

Red flags - bone pain

Question 3

How should prostate Ca be investigated?

Answer 3

DRE

PSA

MRI prostate/pelvis - help decide biopsy technique

TRUS biopsy, transperineal biopsy

Isotope bone scan

Question 4

Outline the Gleason grading system

Answer 4

1 = small uniform glands (WELL DIFF)

2 = more space (stroma) between glands

3 = infiltration of cells from glands at margins (MOD DIFF)

4 = irregular masses of neoplastic cells with few glands

5 = lack of or occasional glands (POORLY DIFF)

Question 5

Outine the signs and symptoms of prostate Ca

Answer 5

Asymptomatic - had PSA test

Nocturia

Hesitancy

Terminal dribbling

Weight loss

Bony pain

Ejaculatory symptoms (rare)

DRE = hard, irregular

Question 6

What are the risk factirs for prostate Ca?

Answer 6

Age

FH (4x 1st degree relative before 60)

BRCA2 (5-7x)

Black-african > white > asian

Question 7

Outline some common causes of a raised PSA

Answer 7

CaP

BPH

Urinary infection

Prostatitis

Acute urinary retention - (check again after 4-6 weeks post-infection)

Question 8

What are the -ves of PSA screening?

Answer 8

Lead time bias - appear to lengthen life as detected earlier but actually die at the same time

Length time bias - overestimation of survival duration due to the relative excess of cases detected that are slowly progressing

Overdiagnosis, over-treatment, co-morbidities of estabilished treatment, co-effectiveness

Question 9

How is metastatic prostate Ca managed?

Answer 9

Surgical castration, medical castration (LHRH agonists), single-dose RT, bisphosphonates

LHRH given as injection (IM/SC) - continuous release (1/3/6m), initially you get more testosterone release (cover with bicalutamide, an anti-androgen), then the system gets overwhelmed and less is released

SE = muscle wasting, thrombosis risk, CVD risk, bone mineral density loss

Question 10

How is locally advanced prostate Ca managed?

Answer 10

Radical RT (if 10y life expectancy) with adjuvant hormones

Question 11

Outline how localised prostate Ca is treated

Answer 11

1 = active surveillance (low risk) DRE, PSA, MRI

2 = radical prostatectomy: robotic (intermediate, high risk)

• ED, incontinence, surgical SE

3 = RT (external/seed brachytherapy) (intermediate, high risk)

• LUTS, rectal symptoms, change in bowel habits, impotence, incontinence

4 = palliative: deferred hormones (WW)

Question 12

What is the most common side effect of RT for prostate Ca?

Answer 12

Urinary frequency

Question 13

Briefly outline PSA results

Answer 13

> 100 = malignant prostate Ca