Prostate cancer

Question 1

PSA counselling

Answer 1

Low PSA doesn’t exclude cancer
High PSA doesn’t confirm cancer
Negative biopsy doesn’t exclude cancer
Positive biopsy may not mean gprogressive cancer and medications have lots of side effects e.g incontinence and impotence

Question 2

Investigating prostate cancer

Answer 2

DRE + PSA
TRUS biopsy
MRI and bone scan to stage

Question 3

Describe Gleason grading

Answer 3

Grades are 3-5. Use sum of 2 highest grades:

Low grade- 3+3=6
Intermediate grade- 3+4=7
High risk- 4+3=7 or 8,9,10

Question 4

Treatment for non mets prostate Ca

Answer 4

DRE and PSA every 6 months and intervene if rapidly progressive
Radical prostatectomy - high risk of UI and impotence
External beam radiotherapy - less UI but same impotence risk
Brachytherapy - need every day for 35 days

Question 5

Treatment for metastatic prostate cancer

Answer 5

Bicalutamide for 28 days to prevent flare of progression (testosterone blocker)
LHRH injection (degarelix) after 14 days and then every month until stable, then every 3/6 months 
Early docetaxol