prostate cancer

Question 1

what is the histology of prostate cancer and how does it respond to testosterone?

Answer 1

• adenocarcinoma

- is androgen dependent, so relies on androgen hormones like testosterone to grow

Question 2

what are the risk factors for prostate cancer?

Answer 2

Increasing age
Family history
Black African or Caribbean origin
Tall stature
Anabolic steroids

Question 3

what are the LUTs that prostate cancer presents with?

Answer 3

LUTS= lower urinary tract symptoms

• hesitancy
• frequency
• weak flow
• terminal dribbling
• noturia

Question 4

apart from LUTS what are the other symptoms of prostate cancer?

Answer 4

• Haematuria
• erectile dysfunction
• metastases–> weight loss, bone pain, caudal equine syndrome

Question 5

is there a PSA screening programme in the UK?

Answer 5

• no because it is not reliable there are lots of false positives and some false negatives
• men >50 can request a PSA if they want

Question 6

how does a benign prostate feel?

Answer 6

feels smooth, symmetrical and slightly soft, with a maintained central sulcus (the dip in the middle between the right and left lobe). There may be generalised enlargement in prostatic hyperplasia.

Question 7

how does an infected prostate (prostatitis feel on examination?

Answer 7

An infected or inflamed prostate (prostatitis) may be enlarged, tender and warm.

Question 8

how will cancerous prostate feel on PR?

Answer 8

firm or hard, asymmetrical, craggy or irregular, with loss of the central sulcus.

Question 9

which imaging is used to investigate prostate cancer?

Answer 9

multi parametric MRI

Question 10

what are the 2 ways of doing a prostate biopsy?

Answer 10

Transrectal ultrasound-guided biopsy involves an ultrasound probe inserted into the rectum, providing a good indicate of the size and shape of the prostate. Guided biopsies are taken through the wall of the rectum, into the prostate.

Transperineal biopsy involves needles inserted through the perineum. It is usually under local anaesthetic.

Question 11

what are the risks of prostate biopsy?

Answer 11

Pain (particularly lower abdominal, rectal or perineal pain)
Bleeding (blood in the stools, urine or semen)
Infection
Urinary retention due to short term swelling of the prostate
Erectile dysfunction (rare)

Question 12

how can the Gleason score be interpreted?

Answer 12

The Gleason score will be made up of two numbers added together for the total score (for example, 3 + 4 = 7):

The first number is the grade of the most prevalent pattern in the biopsy
The second number is the grade of the second most prevalent pattern in the biopsy

6 is considered low risk
7 is intermediate risk (3 + 4 is lower risk than 4 + 3)
8 or above is deemed to be high risk

Question 13

what are side effects of hormone therapy?

Answer 13

Hot flushes
Sexual dysfunction
Gynaecomastia
Fatigue 
Osteoporosis

Question 14

what are the treatment options for prostate cancer?

Answer 14

1. low risk cancer:
   - active surveillance
   - patient must have 10 biopsies and one rebiopsy to confirm they are low risk
   yr 1- PSA every 3-4 months, DRE12 months, MRI 12-18 months
   yr2 onwards- PSA every 6 months, DRE every 12 months
   if there is progression provide radical treatment
2. intermediate risk cancer
   a. radical prostatectomy
   b. radical radiotherapy- risk of proctitis and rectal malignancy
   c. hormone therapy: bilateral orchidectomy or LHRH agonists like goserilin. anti androgens like flutamide should be given in combination with goserlin initially to avoid the initial increase in testosterone

metastatic:
- bilateral orchidectomy and
- anti androgen therapy
and doctaxel chemotherapy

Question 15

what is the advice before getting a PSA done?

Answer 15

Before having a PSA test, men should not have ejaculated during the previous 48 hours.

exercised vigorously in the previous 48 hours

an active urinary infection (PSA may remain raised for many months)

had a prostate biopsy in the previous 6 weeks