Prostate Cancer

Question 1

What is prostate cancer?

Answer 1

Second most common cancer in men
Occurs in 80% of men >80 but only 4% die from it
Most common is adenocarcinoma

Question 2

What are risk factors?

Answer 2

Increasing age
Obesity
Smoking
FH
Afro-caribbean ethnicity 
Raised testosterone levels (cause BPH)

Question 3

What are the clinical features?

Answer 3

Normally asymptomatic 
Can get hesitancy
Urinary retention
Haematouria
Haematospermia 
Weight loss
Pain due to mets

On DRE will have an asymmetrical hard enlarged prostate

Question 4

What investigations are needed?

Answer 4

PSA

• > 10 can indicate cancer
• other causes of raised PSA include recent ejaculation or vigorous exercise (advised to avoid in preceding 48hrs)

Multiparametric MRI

• is imaging modality of choice
• gives score 1-5
• 5= high suspicion

Prostate biopsy

• done if high suspicion (>3)
• can be transrectal or transperineal
• multiple biopsies are taken based on MRI findings
• risks include pain/bleeding/infection/ urinary retention

Bone isotope scan
-to look for bony mets

Question 5

What is the management?

Answer 5

T1/2

• active observation- regular DRE, PSA or biopsies
• prostatectomy- risk of impotence and incontinence
• radiotherapy- increases risk of bladder and breast cancer

T3/4

• radical prostatectomy or radiotherapy
• no difference in outcomes
• can use hormonal therapy

Metastatic disease

• hormonal therapy
• GnRH agonists e.g. goserelin
• cause lowering of LH in the long term to decrease testosterone
• will need cyproterone acetate in the short term to prevent initial increase in testosterone
• can be used palliatively or in higher risk disease