Prostate Cancer

Question 1

Prostate cancer is the most common cancer in adult males.

It is the second most common cause of death in males after X.

Answer 1

Lung cancer

Question 2

What are some risk factors for developing prostate cancer?

Answer 2

• Increasing age
• obesity
• Afro-Caribbean ethinicity
• Family history: around 5-10% of cases have a strong family history

Question 3

What are some features of prostate cancer?

Answer 3

• Bladder outlet obstruction: hesitancy, urinary retention
• Haematuria, haematospermia
• Pain: back, perineal or testicular
• Digital rectal examination: asymmetrical, hard, nodular enlargement with loss of median sulcus

Question 4

What score is used to predict prognosis in prostate cancer?

Answer 4

The Gleason score.

Question 5

The higher the Gleason score……

Answer 5

The worse the prognosis

Question 6

How is the Gleason score determined and what is it’s range?

Answer 6

• It is based on the tissue biopsy.
• The first and second most prevalent patterns seen are added to obtain the Gleason score.
• Grades are between 1-5 and Score between 2-10.

Question 7

How is localized (T1/T2) prostate cancer managed?

Answer 7

Depends on life expectancy and patient choice.

1. Active monitoring/ watchful waiting
2. Radical prostatectomy
3. Radiotherapy

Question 8

How is localized (T3/T4) advanced prostate cancer managed?

Answer 8

• Hormonal therapy
  
  • Synthetic GnRH agonist (e.g. Goserelin [Zoladex], cover initially with anti-androgen to prevent rise in testosterone.)
  • Anti-androgen - cyproterone acetate prevents DHT binding.
• Radical prostatectomy
• Radiotherapy

Question 9

What are the age-adjusted upper limits for PSA recommended by the PCRMP (NHS Prostate Cancer Risk Management Programme)?

Answer 9

50-59 = 3 ng/ml

60-69=4 ng/ml

>70 = 5 ng/ml

Question 10

What else can raise PSA levels?

Answer 10

• Benign prostatic hyperplasia (BPH)
• Prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
• Ejaculation (ideally not in the previous 48 hours)
• Vigorous exercise (ideally not in the previous 48 hours)
• Urinary retention
• Instrumentation of the urinary tract

Question 11

what can be said about the specificity and sensitivity of PSA testing?

Answer 11

It is poor.

Question 12

What percentage of men with a PSA of 4-10 will be found to have prostate cancer?

Answer 12

33%

Question 13

What percentage of men with a PSA of 10-20 will be found to have prostate cancer?

Answer 13

60%

Question 14

What percentage of men with prostate cancer have a normal PSA?

Answer 14

20%

Question 15

What does The Red Whale (GPCPD) recommend as an approach to PSA screening?

(As there is currently no prostate screening programme in the UK)

Answer 15