Prostate Cancer

Question 1

Which conditions can lead to an increased PSA level?

Answer 1

Prostate cancer
Recent DRE
Infection
Catheterisation
Trauma

Question 2

What are the current guidelines for prostate cancer screening?

Answer 2

Before taking test, discuss with patient if it’s going to be of any benefit
Test PSA between 50 and 70 years - no evidence for DRE
If PSA normal, test every 2 years
If PSA positive/abnormal DRE, refer to urologist and biopsy

Question 3

How can a biopsy of the prostate be obtained?

Answer 3

Transrectal ultrasound (TRUS) guided biopsy
MRI images and MRI guided biopsy may have role in salvage prostatectomy/repeat biopsy

Question 4

Does a negative biopsy mean the patient is negative for prostate cancer?

Answer 4

No

Question 5

As PSA has not been shown to be useful for screening, what better supported role does it serve in prostate cancer?

Answer 5

Ongoing management

Question 6

What is a commonly used scoring system for prostate cancer?

Answer 6

Gleason score

Question 7

In which condition can the Gleason score not be used?

Answer 7

Androgen deficiency

Question 8

Has the genetic heterogeneity of prostate cancer been addressed?

Answer 8

Not yet

Question 9

What sort of follow-up do patients with low risk prostate cancer require?

Answer 9

Surveillance

Prostatectomy

Question 10

What is active surveillance?

Answer 10

For patients with low-moderate risk cancers
Don’t need to go for radical prostatectomy yet, but keep an eye on disease, as many prostate cancers are indolent
Because risk of surgery quite high

Question 11

What does active surveillance in prostate cancer involve?

Answer 11

PSA
DRE
If gets worse, treat cancer

Question 12

How can prostate cancer be staged?

Answer 12

Prostate specific Ag (PSA) imaging = radiolabel prostate specific Abs > bind to Ag throughout body > scan with CT
PET scan

Question 13

What are some chemotherapies for prostate cancer, after resection?

Answer 13

Androgen deprivation therapy

LHRH agonists - medical castration - can control cancer for first 12-14 months

Question 14

What are the three presentations of castrate sensitive prostate cancer?

Answer 14

De novo metastasis
Radical prostatectomy previously > metastasis
Well controlled previously on medical treatment > now metastatic

Question 15

To what should treatment of prostate cancer be adapted?

Answer 15

Health status

Question 16

What is the standard treatment of castrate sensitive prostate cancer?

Answer 16

Androgen deprivation therapy

Docetaxal

Question 17

What is the treatment of castrate resistant prostate cancer?

Answer 17

Docetaxal
2nd line endocrine therapy
- Abiraterone
- Enzalutamide

Question 18

What is the treatment for bony metastasis of prostate cancer?

Answer 18

Radium-223

Question 19

What is the most common cancer in males?

Answer 19

Prostate cancer

Question 20

What are the biggest cancer killers in males?

Answer 20

1. Lung
2. Colon
3. Prostate

Question 21

What is the 5-year survival of prostate cancer?

Answer 21

95%

Question 22

What is the point of cancer screening?

Answer 22

Reduce mortality

Have an overall survival benefit

Question 23

What are the risk factors for prostate cancer?

Answer 23

Age
African-American
FHx - BRCA1 and BRCA2 breast cancer

Question 24

What is the interpretation of the Gleason score in prostate cancer?

Answer 24

6 = low risk
7 = intermediate risk
8-10 = high risk

Question 25

Other than the Gleason score, what grading system is used in prostate cancer?

Answer 25

Epstein score

Question 26

What are the CNS side effects of androgen deficiency therapy?

Answer 26

Cognitive change

Low mood

Question 27

What are the cardiovascular side effects of androgen therapy?

Answer 27

Hypercholesterolaemia
IHD risk
Obesity

Question 28

What are the side effects on bone of androgen deficiency therapy?

Answer 28

Osteoporosis

Question 29

What are the general side effects of androgen deficiency therapy?

Answer 29

Lethargy
Reduced libido
Hot flushes