Prostate cancer

Question 1

What are the risk factors assosciated with prostate cancer?

Answer 1

Family history (increases risk by 2-3X)
Increased testosterone

Question 2

What are the symptoms of prostate cancer?

Answer 2

Asymptomatic
Nocturia
Hesitancy
Poor stream
Terminal dribbling
Obstruction
Weight loss (suggests metastasis)
Bone pain (suggests metastasis)

Question 3

How is Prostate cancer diagnosed?

Answer 3

DRE examination of the prostate (hard, craggy)
PSA increased
Transrectal USS and biopsy
X-ray
Bone scan
CT/MRI

Question 4

How is prostate cancer treated?

Answer 4

If the disease is confined to the prostate the options depend on prognosis, patient preference and co-morbidities.

Radical prostatectomy; if >70 gives excellent disease-free survival.

Radical radiotherapy (+/- neoadjuvant, adjuvant hormonal therapy): an alternative curatie option that compares favourably with surgery

Hormone therapy alone: temporarily delays tumour progression but refractory disease eventually develops. Consider in elderly unfit patients with high-risk disease

Active surveillance: consider in patients >70 with low-risk disease

Question 5

How is prostate cancer staged?

Answer 5

TNM staging is used to stage prostate cancer
T1 = The cancer cannot be felt during DRE or seen on scans but is detected on microscopy. The cancer is in only half or one side of the prostate.
T2 = Cancer is more than half of one side of the prostate
T3a = The cancer has broken through the outer layer of the prostate but has not spread to the seminal vesicles
T3b= The cancer has spread to the seminal vesicles
T4 = The cancer has spread to the bladder, rectum, pelvic wall or lymph nodes