Prostate cancer

Question 1

What is the most common cancer in UK males over 50?

Answer 1

Prostate cancer

Question 2

What are some risk factors for prostate cancer?

Answer 2

• Ageing
• Genetics
• Cadmium batteries

Question 3

Is BPH a form of pre-malignant prostate cancer?

Answer 3

NO

Question 4

What are the 3 histological sub-types of prostate cancer?

Answer 4

• Prostatic acinar adenocarcinoma (Most common)
• Prostatic ductal carcinoma
• Small cell carcinoma

Question 5

What are the 3 main zones of the prostate?

Answer 5

Central zone - Surrounding ejaculatory duct
Peripheral zone - Potserolateral, malignant cancers arise here
Transitional zone - Surrounds prostatic urethral, BPH arises here

Question 6

Which zone of the prostate does prostate cancer occur in?

Answer 6

Peripheral zone

Question 7

How will prostate cancer present?

Answer 7

Asymptomatic
Haematospermia
Haematuria
Obstruction - Hesitancy, reduced flow
Bone pain (Metastasis)
Weight loss, anorexia, fever

Question 8

What tests are required in suspected prostate cancer?

Answer 8

PSA
Bloods
PR exam
Trans-rectal US-guided biopsy
MRI and bone scan

Question 9

What is PSA

Answer 9

Prostate Specific Antigen - Glucoprotein enzyme kallikrein 3

Question 10

What is the function of kallikrein 3 (PSA) normally

Answer 10

Liquifies semen in ejeculate and allows sperm to swim

Question 11

What are some things that can cause a raised PSA?

Answer 11

Prostate cancer
BPH
Prostatitis
Ejaculation
Cycling
Sit-down jobs

Question 12

What are some negatives of PSA testing?

Answer 12

Not produced by high grade cancers
15% of negative tests will have cancer
Borderline raised PSAs have a 25% chance of having cancer
Only 50% of cases of raised PSA will have cancer

Question 13

What should be avoided before PSA testing?

Answer 13

Vigorous exercise, cycling and ejaculation for 48 hours before exam
Rectal exam should be done after PSA test

Question 14

What are some prostate characteristics on PR that suggest prostate cancer?

Answer 14

Enlarged
Hard
Irregular
Asymmetrical

Question 15

What score is used to determine prognosis of prostate cancer?

Answer 15

Gleason score

Question 16

How is the Gleason score calculated?

Answer 16

The two most common morphologies of the prostate tumour are determined, then their scores are added together giving a score /10 which determines prognosis

Clinically, only scores 3, 4 and 5 are used

Question 17

What will be seen on bone scan in prostate cancer?

Answer 17

Osteosclerosis

Question 18

How are low grade, localised and slow growing prostate cancers managed?

Answer 18

Follow up examinations to monitor and ensure no progression

Question 19

How is medium/high risk, localised prostate cancer managed?

Answer 19

Prostatectomy
Radiotherapy

Question 20

How is prostatectomy carried out?

Answer 20

Robotically - Most common robotic surgery in the world

Question 21

What are some side effects to prostatectomy?

Answer 21

Most men will have some form of sexual dysfunction following prostatectomy and stress incontinence (Managed by physiotherapy and can go away)

Question 22

What are the 2 forms of radiotherapy used in prostate cancer management?

Answer 22

External beam radiotherapy
Brachytherapy

Question 23

Who is prostatectomy given to in prostate cancer?

Answer 23

Younger patients, so that radiotherapy can be used in cases of relapse (Both procedures are equally effective)

Question 24

What is involved in brachytherapy?

Answer 24

Radioactive implantation around the prostate to target the cancer

Question 25

How is advanced or metastatic prostate cancer managed?

Answer 25

LHRH agonists (Leutenising hormone releasing hormone)
Anti-androgens

Question 26

How do LHRH agonists and anti-androgens help in prostate cancer?

Answer 26

Inhibits testosterone which slows the progression of prostate cancer (Induces a form of male menopause)