Prostate cancer

Question 1

How common?

Answer 1

2nd in men

Question 2

What is a large problem with prostate diagnostics?

Answer 2

Overdiasnosis and overtreatment!!

Question 3

How much higher risk do a man with 1 first degree relative have for prostate ca?

Answer 3

Risk x 2

Question 4

Early symptoms?

Answer 4

Asymptomatic.

Question 5

Advanced symptoms?

Answer 5

Bladder outlet obstruction
Hematuria
UTIs

Question 6

MC metastasis?

Answer 6

BONE

Question 7

Symptoms of metastatic disease?

Answer 7

Bone pain
Fractures
Spinal cord compression

Question 8

Is PSA recommended for screening to decrease mortaliti=

Answer 8

NO! Beneftis of screening are outweighed by harm of overtreatment

Question 9

Screening age for man with average risk?

Answer 9

50 years

Question 10

Screening age for man with high risk?

Answer 10

40-45 years

Question 11

Stop screening at age?

Answer 11

69

Question 12

At what PSA level should you do biopsy?

Answer 12

> 7ng/ml

Question 13

What is diagnosis based on?

Answer 13

HIstopathology

Question 14

How many cores should be taken in biopsy?

Answer 14

min 12!

Question 15

Explain Gleason’ grade?

Answer 15

Grade 1 + 2 is well differentiated
Grade 3 is moderately differentiated
Grade 4 + 5 is poorly differentiated

Question 16

Gleason grade I?

Answer 16

Small, uniform glands

Question 17

Gleason grade II?

Answer 17

More between glands

Question 18

Gleason grade III?

Answer 18

Distintly, infiltrative margins

Question 19

Gleason grade IV?

Answer 19

Irregular masses of neoplastic glands

Question 20

Gleason grade V?

Answer 20

Only occasional gland formation

Question 21

Which gleason grade is most serious:

• 4 + 3
• 3 + 4

Answer 21

4 + 3!

Question 22

MC histology of prostate ca?

Answer 22

Adenocarcinoma (95%)

Question 23

Staging?

Answer 23

TNM

Question 24

How do we calculate risk stratification?

Answer 24

T
PSA level
Gleason score
Comorbidities
Age

Question 25

Management of low risk, localized ca?

Answer 25

ACTIVE SURVEILLANCE (may do radical prostatectomy, radiotx)

Question 26

What is active surveillance?

Answer 26

Measure serum PSA every 3rd month | Repeat prostate biopsy

Question 27

Side effects of radiotx and prostatectimy?

Answer 27

Radiotx: Urinary symptoms, erectile dysfunction Prostatectomy: Incontinence, erectile dysfunction

Question 28

Management of high risk, localized ca?

Answer 28

Radiotherapy | Prostatectomy

Question 29

FIRST line management of metastatic disease?

Answer 29

HORMONAL tx! - androgen suppression (castration, LHRH agonist) - hormonal manipulation (adding/withdrawing Flutamid)

Question 30

Tx of castrate-resistant ca (hormonal ineffective)?

Answer 30

CHEMOTHERAPY = TAXELS (docetaxel, cabacitaxel)

Question 31

Tx of bone metastases?

Answer 31

Radiotherapy!!! Denosumab (inhibits osteoclasts) Surgery Bisphosponates