prostate cancer

Question 1

what kind of carcinoma?

Answer 1

adenocarcinoma

Question 2

where is the most common site of growth of prostate cancer?

Answer 2

Peripheral zone on posterior lobe

Question 3

Local invasion occurs through the prostate into ?

Answer 3

o other pelvic tissue, especially bladder and seminal vesicles.

Question 4

lymphatic spread?

Answer 4

sacral and iliac nodes

Question 5

metastatic spread

Answer 5

bone, lungs and liver

Question 6

what kind of lesions do bone mets cause?

Answer 6

osteosclerotic lesions

Question 7

risk factors for prostate cancer?

Answer 7

age
family history
being black

Question 8

when do LUTS start in prostate cancer compared to BPH?

Answer 8

later and less prominent because of position it starts

Question 9

systemic symptoms of prostate cancer?

Answer 9

weight loss, night sweats, fever, back pain

Question 10

on examination, what would the prostate feel like?

Answer 10

assymetrical, hard, craggy

Question 11

normal range of PSA?

Answer 11

0-4

Question 12

how many men with raised PSA will have prostate canceR

Answer 12

33%

Question 13

what score is used as prognostic score?

Answer 13

gleason score

Question 14

what is the gleason score out of? what score would be low risk, low grade cancer?

Answer 14

10

6

Question 15

gleason 8-10?

Answer 15

high grade, high risk cancer

Question 16

score of less than? indicate no malignant disease?

Answer 16

6

Question 17

additional investigations (for mets and staging)

Answer 17

bone scan 
CT pelvis (for assessing size and lymphadenopathy) 
MRI pelvis (best for staging)

Question 18

management of prostate cancer?

Answer 18

will depend on gleason score

• watchful waiting with PSA measurements
• radical prostatectomy (ED, urethral stricture and LUTS, incontinence)
• external beam radiotherapy (can be used as primary treatment or following surgery)
• Androgen deprivation (GNRH analogue: goserelin) (anti androgen: flutamide)

Question 19

when is androgen deprivation used

Answer 19

used for more intermediate grade tumours and if there are positive lymph nodes

Question 20

is prostate cancer radiosensitive?

Answer 20

can be used as a primary treatment or following surgery if positive margins are found

Question 21

what age of patient would get prostatitis?

Answer 21

under 35

Question 22

what organism is a causative organism of prostatitis?

Answer 22

e coli

Question 23

which STIs can cause prostatitis?

Answer 23

chlamydia and gonorrhoea

Question 24

presentation of prostatitis?

Answer 24

cystitis + flu like symptoms
low backache
urinary retention
haematospermia

Question 25

on examination- prostatitis?

Answer 25

swollen, tender prostate on PR

Question 26

Investigatons (same as epididymo orchidiits)

Answer 26

1st pass urine for chlamydia and gonorrhoea (PCR)

MSSU - UTI

Question 27

1st line treatment of prostatitis

Answer 27

28 day quinolone treatment (ofloxacin or ciprofloxacin)

Question 28

2 quinolone that are used in prostatitis?

Answer 28

ciprofloxacin and ofloxacin

Question 29

in prostatitis, if high risk of c diff - what antibiotic can be used?

Answer 29

trimethoprim