Prostate cancer

Question 1

Risk factors for prostate cancer

Answer 1

*Increasing age
*Androgen exposure
*Black ethnicity
*Family history of prostate or other heritable cancers e.g. breast, colorectal
*High fat diet

Question 2

Prostate cancer symptoms

Answer 2

*Often asymptomatic, found via PSA
*Frequency, urgency, nocturia, hesitancy, dysuria
*Haematuria/haematospermia
*Systemic symptoms: weight loss, weakness, fatigue

Question 3

Prostate cancer examination

Answer 3

*Palpable bladder (outflow obstruction)
*DRE - hard, nodular, asymmetrical

Question 4

Prostate cancer investigations

Answer 4

*PSA - 2 week wait if 3+ and under 70 or 5+ if over 70
*U&Es - kidney dysfunction if obstructed
*Urinalysis for infectious causes
*Multiparametric MRI for lesion
*TRUS biopsy for Gleason grading
*MRI/CTAP for further staging + mets
*Low risk Gleason <7, high >7

Question 5

Prostate cancer treatment

Answer 5

*Active surveillance
*Brachytherapy (cystitis, proctitis)
*External beam radiotherapy (rectum or colon cancer)
*Radial prostatectomy - prostate, seminal vesicles, lymph nodes (incontinence, impotence)

Question 6

Prostate cancer follow up

Answer 6

PSA every 6 months for 5 years then annually
DRE annually