Prostate Cancer

Question 1

What is are the principles of luteinizing hormone releasing hormone (LHRH) agonist therapy?

Answer 1

GnRH stimulation of LH hormone release is usually pulsatile so constant stimulation reduces LH hormone release therefore testosterone.

The initial dosing must be accompanied with an anti-adrogenic agent (bicalutamide) to counteract the initial burst in testosterone

Question 2

What is the treatment of choice for metastatic prostate cancer?

Answer 2

Docetaxel (anti-mitotic chemotherapy)

Question 3

What is active surveillance? When is it used?

Answer 3

6monthly PSA and DRE

12monthly biopsy

For a GLEASON 6 prostate cancer in a patient who is able to tolerate the treatment if required

Question 4

What is the difference between active surveillance and watch full waiting?

Answer 4

In active surveillance the intent is for cure and the screening is more rigorous as the patient is more likely to be able to tolerate the required therapy

In watchful waiting the intention is to paliate therefore the screening is less rigorous. The patient is unlikely to tolerate the required therapy

Question 5

What are the differentials for an elevated PSA?

Answer 5

Prostate cancer

Prostatitis

BPH

Question 6

What are the options of androgen depreviation therapy?

Answer 6

Luteinizing hormone releasing hormone agonists (goserelin)

Question 7

Outline the Gleason scoring system and the implications of scores?

Answer 7

1-10

6 is low risk

7 is medium risk

8-10 is high risk

Question 8

What are the pro’s and con’s of PSA screening?

Answer 8

Pro’s

• It’s a safe, reliable test
• Early treatment is effective at lowering mortality and has low side effects

Con’s

• Overtreatment and over diagnosis
• 2/3 positive tests won’t be prostate cancer

Question 9

What does BPH stand for?

Answer 9

Benign prostatic hyperplasia

Question 10

How many men are diagnosed and die of prostate cancer every year in Australia?

Answer 10

20 000

3500

Question 11

What are investigations available to stage prostate cancers?

Answer 11

MRI

CT

Bone scan

Question 12

How is the diagnosis of prostate cancer confirmed?

Answer 12

Transurethral/transperineal US guided biopsy with 12-20 cores taken and sent for Gleason score

Question 13

What is normal for PSA?

Answer 13

<4ng/ml

Question 14

What are some side effects of adrogenic depreviation therapy?

Answer 14

CNS - Low mood, cognitive change

CVS - Hypercholesteraemia, IHD risk

Bone - Osteoporesis

Obesity

General - Low lidido, lethargy

Question 15

Outline how the Gleason score works

Answer 15

12-20 biopsies are taken and scored with a grade of 1-5 depending on the glandular pattern of differentiation. The two highest scores are added to get a score out of 10

2-4 = Well differentiated cancer

5,6 = Intermediate grade tumour

7 = Moderate to poorly differentiated cancer

8-10 = High-grade tumour

Question 16

What are some risk factors for prostate cancer?

Answer 16

Age

FHx

African-American