Prostate cancer

Question 1

Risk factors for prostate cancer

Answer 1

• age over 50
• black ethnicity
• family history of prostate or heritable (breast, colorectal) cancer
• high dietary fat intake

Question 2

Prostate cancer symptoms

Answer 2

• often picked up while asymptomatic
• storage symptoms - urgency, frequency, nocturia, urge incontinence
• voiding symptoms - weak stream, hesitancy, straining, incomplete emptying
• haematuria or haematospermia
• systemic symptoms - weight loss, fatigue
• bone pain

Question 3

Prostate cancer examination

Answer 3

• asymmetrical prostate
• nodular prostate
• indurated prostate

Question 4

Prostate cancer differential diagnosis

Answer 4

• benign prostatic hyperplasia (smooth enlarged prostate, biopsy clear)
• chronic prostatitis (3 months to 1 year, leukocytes and inflammation)
• raised PSA due to urethral trauma

Question 5

Prostate cancer investigations

Answer 5

• serum PSA
• U&Es - ureter obstruction causing kidney dysfunction
• FBC for anaemia
• LFT due to treatment hepatitis risk
• testosterone levels
• TRUS biopsy
• multiparametric MRI
• for mets - DEXA, CT TAP, PET scan

Question 6

Prostate cancer scoring system

Answer 6

• Gleason histological grading
• TNM staging also used
• grade 1 - low-grade
• grade 2 - intermediate, confined within prostate
• grade 3 - extra-prostatic but not fixed or not invading local structures
• grade 4 - fixed or invading local structures, e.g. rectum, bladder

Question 7

Prostate cancer management

Answer 7

• watchful waiting (no intent to cure)
• active surveillance (curative intent or if refuse active treatment or low risk)
• radical prostatectomy (T1-3 tumour, life expectancy over 10 years)
• external beam radiotherapy (T1-3 tumour, targeted radiation)
• hormone therapy - GnRH (decreased androgen secretion > shrinks prostate and tumour)
• androgen receptor antagonists

Question 8

Prostate cancer treatment side effects

Answer 8

• for hormone therapy:
• hot flushes
• reduced bone density, fractures
• low libido
• erectile dysfunction
• for radical treatment:
• dysuria
• urinary frequency, incontinence
• rectal bleeding (radiotherapy)
• erectile dysfunction (surgery)