Prostate Cancer

Question 1

Prostate Cancer Pathogenesis

Answer 1

The tumour develops at the periphery of the gland and are almost always adenocarcinomas. Growth of the tumour within the gland may cause urethral obstruction and local spread can be to the rectum or bladder neck. Metastases are frequently osteosclerotic (whiter on x-ray)

Question 2

Clinical Presentation of Prostate Cancer

Answer 2

• Often asymptomatic
  
  • LUTS - obstructive symptoms are unrelated to PC
  • Systemic malignancy symptoms

Question 3

Risk Factors of Prostate Cancer

Answer 3

• Testosterone

* FHx of breast cancer in 1st degree relative

Question 4

Prostate Cancer Investigations

Answer 4

• DRE - there is a nodular mass
  
  • Urinalysis & culture
  • CT abdo & pelvis
  • TRUS biopsy (transrectal US)
  • Prostate specific antigen (exact relevance debatable)
    
    • Increased in cancer
    • Further increased if metastases (confirm with bone scan)

Question 5

Prostatic Cancer Stages

Answer 5

Stage 1 - the cancer is small and contained within the prostate.
Stage 2 - the cancer is larger and may be in both lobes of the prostate, but is still confined to the organ.
Stage 3 - the cancer has spread beyond the prostate and may have invaded the adjacent lymph glands or seminal vesicles.
Stage 4 - the cancer has spread to other organs, or to bone.

Question 6

Management for Low Progession Prostate Cancer

Answer 6

Surveillance
Seed bachytherapy
Ext. Beam radiotherapy
Radical resection

Question 7

Management for Intermediate Progession Prostate Cancer

Answer 7

Seed brachytherapy

Radiotherapy & Hormones

Question 8

Management for Severe Progession Prostate Cancer

Answer 8

Radiotherapy & Hormones (LHRH agonist, anti-androgen)

Question 9

Mild, Intermediate & Severe Prostate Cancer Classification

Answer 9

Mild

• PSA < 10
• Gleason’s < 7
• TMN - T1/2a

Intermediate

• PSA 10-20
• Gleason’s = 7
• TMN - T2b/c

Severe

• PSA > 20
• Gleason’s > 7
• TMN - T3/4