Prostate cancer

Question 1

1) The majority of prostate cancer rely on what to grow?
2) Do the majority of prostate tumours grow centrally or peripherally?
3) What is the commonest histological subtype of prostate cancer?

Answer 1

1) Androgens
2) Peripheral
3) Adenocarcinoma

Question 2

Name 2 risk factors for prostate cancer

Answer 2

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

Question 3

Name 2 ways prostate cancer can present

Answer 3

• Asymptomatic
• Lower urinary tract symptoms
• Haematuria
• Erectile dysfunction

Question 4

1) What produces the prostate specific antigen glycoprotein?
2) As well as prostate cancer, name 2 other causes of a raised PSA

Answer 4

1) Epithelial cells of the prostate
2) Benign prostate hyperplasia, prostatitis, UTIs,
vigorous exercise (notably cycling), recent ejaculation or prostate stimulation

Question 5

Name 2 ways a cancerous prostate may feel in a digital rectal exam

Answer 5

• Firm or hard
• Asymmetrical
• Craggy or irregular
• Loss of the central sulcus
• May be a hard nodule

Question 6

1) What is now the usual first line investigation for localised prostate cancer?
2) What is the name of the scale that the results of this investigation is graded on?

Answer 6

1) Multiparametric MRI
2) Likert scale

Question 7

After an MRI and clinical examination, what is the next step in establishing a diagnosis?

Answer 7

Biopsy

Question 8

What are the 2 options for prostate biopsy?

Answer 8

• Transrectal ultrasound-guided biopsy (TRUS)
• Transperineal biopsy

Question 9

What is the grading system that determines what treatment is most appropriate (that’s based on histology from the prostate biopsies) called?

Answer 9

Gleason grading system

Question 10

Name 2 options for the management of localised prostate cancer

Answer 10

• Conservative: active monitoring & watchful waiting
• Radical prostatectomy
• Radiotherapy: external beam and brachytherapy (implanting radioactive metal “seeds” into the prostate to deliver continuous, targeted radiotherapy at the prostate)

Question 11

Name 2 options for the management of localised advanced prostate cancer

Answer 11

• Hormonal therapy (androgen-receptor blockers i.e. bicalutamide and GnRH agonists i.e. goserelin or leuprorelin
• Radical prostatectomy
• Radiotherapy (external beam and brachytherapy)

Question 12

How is metastatic prostate cancer treated?

Answer 12

Hormone therapy

Question 13

Name 2 side effects of hormone therapy in prostate cancer treatment

Answer 13

• Hot flushes
• Sexual dysfunction
• Gynaecomastia
• Fatigue
• Osteoporosis

Question 14

Name a complication of radical prostatectomy

Answer 14

• Erectile dysfunction
• Urinary incontinence

Question 15

What is the commonest type of prostate cancer?

Answer 15

Adenocarcinoma