Prostate Cancer

Question 1

Definition of prostate cancer

Answer 1

Is a malignant tumour of glandular origin that is situated in the prostate

Question 2

Aetiology/risk factors of prostate cancer

Answer 2

• Unknown aetiology
• Risk factors:
• Increasing age (age >50 years old)
• Family history
• Ethnicity (African American)
• High fat diet

The most common male cancer

Question 3

History and examination of prostate cancer

Answer 3

• Often ASYMPTOMATIC
• Urinary tract obstruction symptoms:
◦ Nocturia
◦ Urinary frequency
◦ Urinary hesitancy
◦ Dysuria
◦ Haematuria
◦ Incomplete void sensation
◦ Dribbling
◦ Poor stream
• Metastatic spread/general symptoms:
◦ Bone pain
◦ Weight loss, anorexia, fatigue
◦ Palpable lymph nodes
• Abnormal DRE: asymmetric or nodular, hard prostate may suggest cancer, increased size too

Question 4

Investigations for prostate cancer

Answer 4

• Serum PSA: elevated PSA would be seen, however it is NOT specific for prostate cancer (can also be elevated with UTI, prostatitis, BPH)
• Prebiopsy MRI: can help identify candidates for biopsy and is able to visualise extent of tumour (for staging)
• Trans perineal prostate BIOPSY: Required to confirm diagnosis, obtained with core needle biopsy. Negative biopsy does NOT exclude tumour especially if PSA is high + signs

Question 5

Treatment of prostate cancer

Answer 5

If young/fit with LOW grade cancer:
1) Active surveillance: Involves regular PSA, MRI and biopsy to monitor progress.
+ Brachytherapy: can be given for low risk, would involve implantation of radioactive sources into the prostate without incision
OR
+ External beam radiotherapy

If young/fit with HIGH grade cancer:
1) Radical prostatectomy/ Radical radiotherapy:
◦ Both are able to give definitive cure to the patient
◦ Post-prostatectomy, the PSA should be undetectable or very very low, if increases then there is a relapse
◦ Prostatectomy can remove the proximal urethral sphincter (can lead to urinary incontinence)
◦ Can also lead to erectile dysfunction due to cavernous sinus nerve damage

If old/unfit with LOW grade cancer:
1) Watchful waiting: regular PSA testing

If old/unfit with HIGH grade cancer:
1) Hormone therapy: Androgen Deprivation Therapy: Lutenisisng hormone-releasing hormone agonist or antagonist (LHRH). E.g Leuprorelin, goserelin (agonist), degarelix (antagonist). Would stimulate and then inhibit pituitary gonadotrophin

Question 6

Prevention and prognosis of prostate cancer

Answer 6

• Low fat diet, may take 5 alpha reductase inhibitors (finasteride) to reduce risk

Prostate cancer is often curable, but prognosis depends on stage
Side effects from treatment may affect morbidity

Question 7

Complications of prostate cancer

Answer 7

• Metastases symptoms: e.g bone pain
• Radiation related side effects
• Prostatectomy side effects