Prostate Cancer

Question 1

Patients with prostate cancer are often asymptomatic, what could be a potential sign of prostate cancer?

Answer 1

Hard irregular nodule of the prostate on DRE

Question 2

39yo male patient asks whether he should be screened for prostate cancer, what would you advise?

Answer 2

No screening

Question 3

59yo male patient sees you for prostate cancer screening, what do you advise?

Answer 3

Weak recommendation for screening

Advise regarding risks of biopsy if screen is positive

Question 4

72yo male patient would like advice regarding prostate cancer screening, what do you advise

Answer 4

No screening in patients >70yo OR life expectancy LESS than 10 years

Question 5

How would you screen for prostate cancer?

Answer 5

Prostate Serum Antigen (PSA) and DRE annually

Question 6

What is the risk of prostate screening?

Answer 6

False positive PSA elevation which would lead to prostate biopsy causing potentially unnecessary increased morbidity.

Prostate Biopsy risks: hematuria (most common), infection, hospital admission, death

Question 7

In what conditions would you not order a PSA?

Answer 7

Acute UTI
Acute/Chronic prostatitis
Urinary retention
Recent catheterization

Question 8

List FIVE cause of elevated PSA

Answer 8

• Mechanical manipulation of prostate: cystoscopy, prostate Bx, catheterization
• Prostate Cancer
• Benign Prostatic Hypertrophy
• Prostate infection/inflammation (Prostatits)
• Perineal trauma
• Sexual activity
• DRE

Question 9

What is a Gleason score?

Answer 9

Prostate biopsy is an additive score of 2 physicians on scale 1-5 indicating differentiation of cancer (invasive severity)
1-4 = well differentiated
5-7 = moderately
8-10 = poorly

Question 10

Where are prostate cancers most likely to metastasize?

Answer 10

Bone
Adrenal glands
Liver
Lung

BALL

Question 11

How would you treat pain associated with bone metastasis?

Answer 11

Opioids
Non-steroidal anti-inflammatory drugs
Corticosteroids
Bisphosphonates
Radiation

Question 12

What are treatment options for prostate cancer?

Answer 12

Radical prostatectomy
Radiation - external beam radiotherapy or prostate brachytherapy
Chemotherapy - androgen deprivation therapy
Cryotherapy

Question 13

List TWO common side-effects of radical prostatectomy

Answer 13

Erectile dysfunction (NNH=3)
Urinary incontinence (NNH=5)
Bleeding
Infection

Question 14

List TWO common side effects of radiotherapy

Answer 14

Erectile dysfunction
Bowel Dysfunction
Colitis
Skin irritation

Question 15

In what patients would you refer for radical prostatectomy rather than watchful waiting?

Answer 15

Male patients

Question 16

List FIVE risk factors for prostate cancer

Answer 16

Male gender
Black guys
Smoking
High fat diet
Family history