Prostate Cancer

Question 1

is it the most common male cancer?

Answer 1

Yes

Question 2

RF?

Answer 2

Age, Fhx, Afro-Caribbean family origin, ↑testosterone,

Question 3

Presentation

Answer 3

LUTS (nocturia, hesitancy, poor stream, terminal dribbling),

UTI’s, 
haematuria, 
↓ weight/appetite, 
pain in the pelvis/back/rib 
and bone pain (mets)

Question 4

Dx?

why do you have to be careful with PSA?

Answer 4

PSA - ↑ (N in 30%)
DRE - Hard, irregular and asymmetrical prostate
Biopsy* - Trans-rectal US or template  
Bone scan
CT/MRI

normal increases with age
50-60 (3.0 max),
60-70 (4.0 max),
70-80 (5.0 max)

Question 5

Mx?

if confined to prostate?

if metastatic?

Answer 5

Confined to the prostate

Watchful waiting
Radical prostatectomy
Radical radiotherapy – External beam or brachytherapy

Hormone therapy:
LHRH agonists (Goserelin) – Result in a flare
LHRH antagonists (Degarelix) – less flare, Effective for advanced cancer
Anti-androgens (Cyproterone acetate) - commonly used in combination with Goserelin to lessen the flare

if metastatic;

just hormone therapy