Prostate cancer

Question 1

what are the steps in treatment in early stages prostate cancer

Answer 1

watchful waiting- active follow ups with PSA, best option for low grade tumours and life expectancy under 10 years
radical radiotherapy- most common, may cause damage to adjacent organs, acute diarrhoea, chronic proctitis
Radical prostatectomy- younger patients, surgery is better option but may cause complete incontinence and impotence

Question 2

at what age can men choose to have a PSA

Answer 2

50
Can also be a sign of an enlarged prostate, UTI, prostatitis,
rectal examination
survey for focal bone tenderness
x ray of chest and any signs of bone pain
transrectal ultrasound
bone scan

Question 3

what is the clinical presentation of prostate cnacer

Answer 3

many asymptomatic
locally advanced disease presents with urinary frequency, poor urine flow or difficulty starting or stopping urination
there may also be bone pain due to metastatic disease, lethargy and weight loss

Question 4

What are the treatments for locally advanced t3/4 prostate cancer

Answer 4

treated with hormonal therapies - LHRH analogues with or without androgens
LHRH analogues e.g leuprorelin, goserelin
cause chemical castration (orchidectomy) via testosterone production
can cause flare in first 1-2 weeks
antiandrogens e.g bicalutamide, flutamide, cyproterone started 3-7 days prior to therapy to prevent the flare

Question 5

what are the side effects of antiandrogens

Answer 5

breast tenderness, gynaecomastia, haematuria, sexual dysfunction

Question 6

what are the side effects of LHRH analogues

Answer 6

hot flushes, sexual dyfunction and impotence

flare in the first week can cause spinal compression, ureteric obstruction or increasing bone pain