Prostate Cancer

Question 1

What is the histology of prostate cancers?

Answer 1

• adenocarcinoma (glandular) in the posterior prostate

Question 2

If there is hypertrophy of the centre of the gland what is it likely to be?

Answer 2

• BPH

Question 3

How might they present?

Answer 3

• frequently asymptomatic and diagnosed by DRE
• nocturia
• dribbling
• poor stream
• metastatic disease: bone pain/ pathological fracture

Question 4

How will it feel on DRE?

Answer 4

• enlarged
• hard, craggy
• obliteration of median sulcus

Question 5

What investigations will be done?

Answer 5

• transrectal biopsy under ultrasound

- PSA

Question 6

What does PSA concentration in biopsy tissue indicate?

Answer 6

• low PSA indicates localised disease

- higher PSA indicates occult metastases and changes treatment

Question 7

Describe the TNM staging system

Answer 7

• T1: split into a, b, c depending on how much tumour tissue
• T2: (a,b,c) tumour confined within prostate
• T3: tumour extends through capsule (a), invades seminal vesicle (b)
• T4: tumour invades adjacent structures e.g. bladder neck

N0- no regional lymph node involvement
N1- regional lymph nodes

M1 a,b,c- depends on bone involvement

Question 8

What is the most common tumour grading system?

Answer 8

• Gleason system scores from 2 to 10 on histological pattern

Question 9

Why may it be a good idea to do nothing to manage these patients?

Answer 9

• many will die from concomitant medical problems

- in patients with asymptomatic disease, confined to prostate observation may be appropriate

Question 10

When is surgery indicated?

Answer 10

• localised disease (T2) a radical prostatectomy can be performed
• palliative: TURP

Question 11

When is radiotherapy indicated?

How can it be delivered?

Answer 11

• in T1/2 tumours with low PSA (indicating no occult mets)
• Adjuvant radiotherapy following surgery
• Palliative
• External beam irradiation
• brachytherapy

Question 12

How might hormonal therapy be employed in prostate cancer?

Answer 12

• neo- adjuvant, to “downstage” tumour

- in advanced disease, has a response rate of 80%

Question 13

What hormone therapy can be given?

Answer 13

• LHRH agonists
• oestrogen therapy
• anti-androgens
• Bilateral orchidectomy

Question 14

Why is oestrogen therapy commonly not given?

Answer 14

• side effects include gynaecomastia, MI, CVA, PE