Prostate Cancer

Question 1

Pathology, grading and staging

Answer 1

Generally adenocarcinoma in peripheral zone and multi focal
Histology graded Gleason two sets of scores for most common architecture under low magnification
Staging local spread, lymphatic iliac➡️ para inguinal and supra clavicular. Haematogenous BONE. Osteosclerotic blastic pic on X-ray like Padgets

Question 2

PSA: ddx, origin, place in prostate ca

Answer 2

PSA is a glycoprotein made by he epithelial cells of the prostate therefore organ specific

Causes liquefaction of ejaculate to help sperm

Ddx: prostate ca, BPH, prostatitis, urinary retention post procedural, increases with age

Normal bet 0-4

In ca use PSA for indi for prostate biopsy and need to work out free to total ratio

Question 3

Treatment

Answer 3

Curative vs palliative
Curative
Radical prostatectomy: prostate and seminal
vesicles removed (hemorrhage, ED 75%,
incontinence 5%) open vs lapro vs robotic assist

External beam radiotherapy ED, radiation proctitis,
transient irratative bladder symptoms

Brachytherapy

Active surveillance

Palliative 
  Watchful waiting
   Hormonal androgen deprivation therapy: LHRH 
   agonist zoladex 
   Bilateral orchidectomy 
   Oestrogens 
   Anti androgens flutamide/ eulexin 
   Tunnel TURP
    Bone pain radiotherapy

Question 4

Spinal cord compression

NB‼️ neurological emergency

Answer 4

Occurs in 10%
Most lesions in the epidural space
Bone pain precedes spinal cord compressing
Motor function➡️paraparesis or paraplegia; sensory loss ➡️ urinary retention
Usually osteoscleotic lesion on X-ray
Mx: high dose steroids (dexamethazone) urgent castration, radiation. Paraparesis and no hormonal treated pts do best

Question 5

Etiology

Answer 5

Genetic: 10% fam hx, fam hx also leads to
                earlier onset  white 
Geographically 
Hormones: needs androgens for growth
BPH