Prostate Cancer

Question 1

5 signs and symptoms

Answer 1

•	Usually asymptomatic
•	LUTS * less common
o	Storage + voiding
o	Incontinence
•	Lower back pain
•	DRE: hard, irregular nodule or diffuse dense induration involving one or both lobes

Question 2

5 Risk Factors

Answer 2

• Age: 60-85 (mean age of diagnosis 72)
• Male (duh)
• Urban African American
• Family Hx (↑risk 1st degree, ↑↑risk with 1st + 2nd degree)
• Cigarettes
• High fat diet

Question 3

CPTF screening recommendations

Answer 3

55-69 NO PSA screening

Question 4

When do you order a PSA

Answer 4

• Abnormal DRE
• LUTS
• Interested men after discussing risks / benefits
• F/U of a man with prostate CA

Question 5

When do you NOT order a PSA

Answer 5

• UTI, prostatitis, urinary retention, recent catheterization
• Life expectancy < 10 years

Question 6

Name 3 adjunctive investigations and their indications

Answer 6

• Transrectal U/S: for size and local staging
• CT: to scan for metastases in moderate to severe risk
• Bone scan: may be omitted if untreated CA with PSA < 10

Question 7

Complications of radical prostatectomy

Answer 7

• Urinary incontinence

Question 8

Complications of radiation

Answer 8

• Bowel dysfunction

Question 9

You have a patient with a PSA of 22, what do you do?

Answer 9

Psa <10 - low risk, routine
Psa 10-20- refer semi urgent!
Psa >20 HI RISK, URGENT referral for prostate biopsy

Upgrade if prostate FIRM/IRREGULAR
Psa< 10, with abnormal prostate- non urgent referral
Psa > 10 and abnormal prostate - URGENT

Question 10

What are 4 risk factors for PCA?

Answer 10

45 yrs
High risk race (urban African American)
Family hx
Smoking
Obesity