Prostate Cancer

Question 1

What are the risk factors for prostate cancer?

Answer 1

Non-modifiable - African ethnicity, BRCA gene, family history and increasing age.
Modifiable risk factors - Obesity, smoking and diet rich in animal fats

Question 2

What are the signs and symptoms for prostate cancer?

Answer 2

• LUTS such as hesitancy, terminal dribbling, incomplete emptying, urgency and frequency.
• Poor urine stream,
• Hematospermia (blood in sperm)
• Pelvic discomfort
• Bone pain,
• Erectile disfunction
• Anorexia or weight loss

Question 3

What are the differential diagnosis for prostate cancer?

Answer 3

• Benign prostatic hyperplasia
• Prostatitis
• UTI
• bladder cancer

Question 4

What is the pathology of prostate cancer?

Answer 4

> 95% are adenocarcinomas and the majority arise from the peripheral zones.
Either acinar adenocarcinoma (originating from glandular cells and is the most common) or ductal adenocarcinoma (originates from the ducts, grows quicker)

Question 5

What are the investigations for prostate cancer?

Answer 5

1. History and exam, including DRE and urine dip.
2. Bloods - PSA
3. Imaging. First line is multiparametric MRI. If intermediate or high risk then do CT CAP.
4. Transperineal ultrasound-guided biopsy

Question 6

What are the complications of a TRUS biopsy?

Answer 6

• Sepsis,
• Pain
• Fever
• Haematuria
• Rectal bleeding

Question 7

What are the further investigations depending the Likert MRI score?

Answer 7

MRI comes first, then if Likert scale is 3 or more a biopsy is offered. If likert scale is 1-2 then the pros and cons of a biopsy must be discussed.

Question 8

What are some non-malignant caused of a raised PSA?

Answer 8

BPH, prostatitis, UTI, recent urological surjury, recent ejaculation, mechanical stimulation (do exam after taking bloods) and urinary retention.

Question 9

What is the Gleason grading score?

Answer 9

It is a score given based in the morphological features of the prostate tissue. 1 = normal tissue and 5 = very poorly differnetiated

Question 10

What is the management of localised prostate cancer? (T1/T2)

Answer 10

• Conservative with watch and weight.
• Radical prostatectomy
• Radiotherapy (external and brachy)

Question 11

What are the options for locally advanced prostate cancer (T3/4

Answer 11

• Radical prostatectomy
• Radiotherapy (external beam and brachy)
• Hormonal therapy

Question 12

What is the treatment for metastatic disease?

Answer 12

Chemotherapt and anti-hormonal agents

Question 13

What is a radical prostatectomy and the complications?

Answer 13

• Removal of the prostate, resection of seminal vesicles +/- lymph nodes
• Side effects are erectile dysfunction, stress incontinence and bladder neck stenosis

Question 14

What are the hormonal treatments for prostate cancer?

Answer 14

• GnRH agonist/antagonist
• Antiandrogens (steroidal and non-steroidal)

Question 15

Describe features of GnRH agonists

Answer 15

Eg, Goserelin.
These paradoxically result in lower LH levels by causing long term overstimulation

Question 15

What is an issue with GnRH agonists

Answer 15

They cause a tumour flare due to an increase in testosterone for the first 2-3 weeks. So need to use an anti-androgen alongside

Question 15

What are the symptoms of a tumour flare?

Answer 15

Bone pain, bladder obstruction and others

Question 16

Name a non-steroidal antiandrogen

Answer 16

Bicalutamide

Question 17

Name a steroidal anti-androgen

Answer 17

Cyproterone acetate. Not used as often now there are non-steroidal options

Question 18

What treatment can be used in hormone-relapsed metastatic prostate cancer?

Answer 18

Abriaterone

Question 19

what chemotherapy agent is used in prostate cancer?

Answer 19

Docetaxel

Question 20

What are metastatic complications of prostate cancer?

Answer 20

Spinal cord compression
Ureteric obstruction

Question 21

What are the upper limits for PSA?

Answer 21

Ages 50-59 = 3
Ages 60-69 = 4
Ages > 70 = 5

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