Prostate Cancer Flashcards
EPIDEMIOLOGY
Where does rank in most common cancers in men
Most common cancer in men
Fast or slow growing
Often very slow growing and do not cause death
Hormonal dependent?
Almost always androgen dependent, relying on androgen hormones (eg testosterone) to grow
Histological classification and where on prostate
Majority are adenocarcinomas
Grow in peripheral zone of prostate
AETIOLOGY
Risk factors
- Increasing age
- FH
- Black african or caribbean origin
- Tall stature
- Anabolic steroids
CLINICAL FEATURES
Presentation
- May be asymptomatic
- May present with lower urinary tract symptoms, similar to BPH
- Hesitancy
- Frequency
- Weak flow
- Terminal dribbling
- Nocturia
- Haematuria
- Erectile dysfunction
- Symptoms of advance disease or metastasis
- Weight loss
- Bone pain
- Cauda equina syndrome
CLINICAL FEATURES
Prostate examination findings
- Firm or hard
- Asymmetrical or irregular
- Loss of central sulcas
- Hard nodule
Prostate exam findings for infected prostate
Enlarged, tender and warm
Prostate exam findings for benign prostate
- Smooth, symmetrical and slightly soft
- Central sulcus present
- May be generalised enlargement in prostatic hyperplasia
INVESTIGATIONS
First choice
- Serum prostate-specific antigen (PSA)
- Multiparametric MRI
- Prostate biopsy - establish diagnosis
- Isotope bone scan - bony metastasis
Problems with PSA test
High rate of false positives (75%) and false negatives (15%)
Common causes of raised PSA
- Prostate cancer
- Benign prostatic hyperplasia
- Prostitis
- UTI
- Vigorous exercise
- Recent ejaculation or prostate stimulation
How are results of multiparametric MRI displayed
- Likert scale
- 1 - very low suspicion
- 2 - low suspicion
- 3 - equivocal
- 4 - probable cancer
- 5 - definite cancer
INVESTIGATIONS
Options for prostate biopsy
- Transrectal ultrasound guided biopsy (TRUS)
- Transperineal biopsy
Risks of prostate biopsy
- Pain
- Bleeding
- Infection
- Urinary retention
- Erectile dysfunction
