Prostate Cancer

Question 1

Epidemiology of prostate cancer

Answer 1

Most common cancer in males

3rd leading cause of male cancer deaths (risk of death 3%)

Question 2

Types of prostate cancer

Answer 2

Adenocarcinoma (>95%; from acini of prostatic ducts)
Urothelial carcinoma (4.5%)
Endometrial (carcinoma of prostatic utricle)

Question 3

Anatomy of prostate cancer

Answer 3

60-70% peripheral zone
10-20% transition zone
5-10% central zone

Question 4

Characteristics of urothelial carcinoma

Answer 4

Associated with bladder TCC

Not hormone responsive

Question 5

Risk factors for prostate cancer

Answer 5

Age
FHx
African descent
Increased testosterone
High fat intake
Smoking

Question 6

Lymph node spread of prostate cancer

Answer 6

Obturator
Iliac
Presacral/para-aortic

Question 7

Clinical presentation of prostate cancer

Answer 7

Usually asymptomatic (symptoms usually indicate local invasion)
LUTS (obstructive, irritative, incontinence)
Erectile dysfunction
Back pain

Question 8

Red flags for prostate cancer

Answer 8

Elderly, incontinent, back pain

Question 9

Most common sites of metastasis for prostate cancer

Answer 9

Axial skeleton

Liver, lung, adrenals

Question 10

Complications of LN spread in prostate cancer

Answer 10

Leg pain and oedema (obstruction of lymphatic and venous drainage)

Question 11

Prostate cancer Ix

Answer 11

FBE: anaemia (advanced disease)
UEC: local spread impairs renal function
LFT: baseline for androgen deprivation therapy (risk of hepatitis)
Testosterone: baseline for androgen deprivation therapy
DRE: hard, irregular nodule or diffuse induration
PSA: caution with interpretation
TRUS/TRUS guided biopsy: based on results of DRE and PSA, risk factors
MRI, CT, bone scan