PROSTATE CANCER

Question 0

Symptoms of locally advanced disease?

Answer 0

Haematuria
Haematospermia
Urinary outflow obstruction
Lower extremity oedema: spreads to lymph nodes
Erectile dysfunction: compression of neurocascular bundle

Question 1

Risk factors for prostate cancer?

Answer 1

Age 
FHx
Smoking
Prostate intraepithelial neoplasia
High dietary fs

Question 2

Pr exam findings? Why important?

Answer 2

Asymmetrical irregularity of gland has ~50% chance of being cancer

20% of PATIENTS will have a normal PSA

Question 3

How else might PROSTATE cancer present?

Answer 3

Metastases

• lower back pain
• pathological fractures
• spinal cord compression

Question 4

Investigations?

Answer 4

CBE EUC LFT
PSA

Biopsy with TRANSRECTAL ultrasound guided prostate biopsy
Look for mets
- WBBS
- CT lung, liver

Question 5

What can raise Serum psa?

Answer 5

Prostate biopsy 
TURP
Prostatis 
Urinary retention
Ejaculation within an hour of the test

Question 6

Treatment?

Answer 6

Dilemna is whether cancer is aggressive enough, or whether won’t harm patient

Pts that will benefit from treatment are those with life expectancy > 10 years

Otherwise surveillance, radical prostatectomy, external beam radiation therapy

Question 7

What is preferred treatment modality in T3?

Answer 7

External bean radiotherapy

Question 8

How do you manage metastatic disease?

Answer 8

Androgen deprivation therapy

• surgical castration
• medical castration: GnRH agonists

Complete androgen block used on conjunction because 5% testosterone released from adrenal gland.

Bisphosphonates

Question 9

Follow up?

Answer 9

PSA levels 6 weeks after treatment, then every 6 months for 1st 2 years, then annually.

Question 10

Complications of treatment?

Answer 10

TRUS biopsy: 1% risk of gram-ve sepsis

Radical prostatectomy: incontinence and impotence

Radiation

• sterile cystitis
• GIT Sx
• GU Sx

Androgen deprivation therapy: hot flushes, weight gain, diminished libido, gynaecomastia, metabolic syndrome, OP