Prostate cancer

Question 1

How many anatomical lobes does the prostate have?

Answer 1

5

Question 2

How many pathological zones does the prostate have?

Answer 2

4

Question 3

Which zone are most prostate cancers in?

Answer 3

peripheral zone

Question 4

Which lobe can be palpated during a DRE?

Answer 4

posterior

Question 5

Prostate cancer risk factors

Answer 5

increasing age
family history
ethnicity (afro-caribbean men)
germline mutations (BRCA1 and BRCA2)
diet (high in saturated fat)

Question 6

What is the main pathological type of prostate cancer?

Answer 6

adenocarcinoma

Question 7

Which local structures can prostate cancer spread to?

Answer 7

seminal vesicles
bladder
rectum

Question 8

Which lymph nodes does prostate cancer spread to?

Answer 8

pelvic
para-aortic

Question 9

Which distant organs does prostate cancer spread to?

Answer 9

bone
liver
lung

Question 10

Prostate cancer clinical presentation

Answer 10

asymptomatic (incidental raised PSA)
LUTS (frequency, urgency, dysuria, nocturia, poor stream, hesitancy)
haematuria
perineal pain

bone pain

Question 11

Prostate cancer investigation

Answer 11

PSA (2 raised at least)
DRE
pre-biopsy multiparametric MRI
Biopsy
CT if PSA>40
radionuclide bone scan

Question 12

What is Gleason scoring in prostate cancer?

Answer 12

based on microscopic appearance of biopsy specimen
measure of aggressiveness of tumour

Question 13

What score is used to grade prostate cancer and predict prognosis?

Answer 13

Gleason score

Question 14

T staging for prostate cancer (part of TNM)

Answer 14

T = no palpable or visible tumour on imaging
T2 = palpable tumour confined to prostate
T3 = tumour extends through prostatic capsule
T4 = tumour invades adjacent structures

Question 15

What radical treatments are available for prostate cancer?

Answer 15

surgery
external beam radiotherapy
interstitial brachytherapy

Question 16

Risks of radical prostate resection?

Answer 16

erectile dysfunction
urinary disturbance
urinary incontinence

Question 17

Risks of external beam radiotherapy/interstitial brachytherapy for prostate cancer?

Answer 17

erectile dysfunction
urinary disturbance
bowel disturbance
late secondary cancers

Question 18

Prostate cancer treatment for locally advanced and metastatic disease?

Answer 18

locally advanced = radical or palliative treatment (radiotherapy, hormone therapy)

metastatic = palliative (hormone, radiotherapy to specific sites, androgen receptor therapy, chemotherapy, bisphosphonates, best supportive care)

Question 19

What drugs can be used for hormone therapy in prostate cancer?

Answer 19

(‘androgen deprivation therapy’)

gonadotrophin-releasing hormone analogues (LHRH analogues) = goserelin

androgen receptor antagonists = bicalutamide

androgen synthesis inhibitors (CYP17) = abiraterone

oestrogens = diethylstilboestrol

orchidectomy

Question 20

Side effects of hormone therapy for prostate cancer

Answer 20

hot flushes
reduced libido
erectile dysfunction
gynaecomastia
osteopaenia
sarcopaenia
insulin resistance
weight gain
mood swings
fatigue

Question 21

Spinal cord compression signs

Answer 21

tender to palpation
reduced power in legs
reduced sensation
reduced anal tone
urinary retention

Question 22

Spinal cord compression immediate management

Answer 22

high dose steroid until definitive treatment - dexamethasone 16mg per day, PPI for gastroprotection

urgent MRI whole spine - can have multiple areas of compression, symptoms do not predict level of compression

Question 23

Spinal cord compression continuing management

Answer 23

decompression surgery
radiotherapy
interventional radiology (vertebroplasty/kyphoplasty)
supportive care