Prostate cancer

Question 1

Summarise the epidemiology of prostate cancer

Answer 1

• Most common male-specific cancer in the West
• Affects 1 in 12 British men
• Prevalence of both latent and clinically detected prostate cancer increases dramatically w/age: 20-30% of men >50 vs. 50% of men >80 have latent prostate cancer

Question 2

What are the clinical features of prostate cancer?

Answer 2

• Enlarged prostate on rectal examination
• Urinary retention, frequency, hesitation
• Nocturia
• Impotence
• Back pain
• Haematuria
• [PSA] > 4ng/ml
• Increased polycomb group gene EZH2 (metastatic)

Question 3

What methods are used to diagnose and monitor prostate cancer?

Answer 3

Positive PSA > 4ng/ml
Positive DRE - enlarged prostate
Prostate biopsy
Gleason scoring to grade

Question 4

What are the different therapies used to treat prostate cancer?

Answer 4

1. Watchful waiting/active observation if tumour may remain latent for rest of patient’s lifespan
2. Radical prostatectomy if tumour confined to prostate gland
3. External beam radiotherapy if tumour has spread outside prostate capsule but not to other organs
4. Brachytherapy if tumour contained in prostate
5. Hormone therapy - bilateral orchidectomy w/LHRH analogue + anti-androgens