Prostate Cancer

Question 1

What is the histology of prostate cancer?

Answer 1

Adenocarcinoma arising from epithelial cells in the peripheral prostate.

Question 2

How does prostate cancer spread and what are the sites of metastases?

Answer 2

1. Local - seminal vesicles, bladder, rectum

2. Lymph/blood - sclerotic bone lesions

Question 3

What is the premalignant form of prostate cancer?

Answer 3

Prostatic intraepithelial neoplasia

Question 4

What are the risk factors for prostate cancer?

Answer 4

1. Age (80% of men >80 years)
2. FHx (increases risk by 2-3x)
3. North American and North-Western European descent
4. High testosterone
5. Afro-Caribbean

Question 5

What are the two typical presentations of prostate cancer?

Answer 5

1. Latent - asymptomatic, raised PSA, biopsy diagnoses.

2. Symptomatic - primary tumour (late) or effect of metastases (earlier)

Question 6

What is this a presentation of?

Loss of weight and bone pain. Nocturia, hesitancy, poor flow, terminal dribbling, urinary obstruction.

Answer 6

Prostate cancer (late)

Question 7

How is suspected prostate cancer investigated?

Answer 7

1. PR exam may show hard, irregular prostate.
2. Raised age matched PSA
3. FBC, U&Es, LFTs
4. Transperineal biopsy
5. Bone scan, CT/MRI
6. Staging using MRI

Question 8

What is Gleason scoring and what is it for?

Answer 8

1. Two separate scores added together from two sites of a prostate, 1-5 + 1-5 = 2-10.
2. Prostate cancer

Question 9

What is the management for prostate cancer?

Answer 9

1. Active surveillance - biopsies, PSA, DRE
2. Watchful waiting - older, more co-morbidities
3. Androgen deprivation - delays tumour progression, LHRH agonist.
4. External beam radiotherapy, brachytherapy.
5. Radical prostatectomy - only definitive cure. SE: urinary incontinence, ED, bladder and bowel issues.