Prostate Cancer

Question 1

Why is prostate cancer important in the UK?

Answer 1

Commonest cancer in men

2nd commonest cause of death from cancer in men

1 in 8 men will be diagnosed with prostate cancer during their lifetime.

Incidence in increasing

Mortality started decreasing in the last decade

Rare in men under 50

Nearly every man in their 80s has prostate cancer

• Most don’t know or need to know they have it
• Most will die with it, not from it.

Question 2

What are the risk factors for prostate cancer?

Answer 2

Increasing age
Family history - one 1st degree relative diagnosed with prostate cancer before 60

BRACA2 gene mutation

Ethnicity:
Black> White > Asian

Question 3

What is the NHS policy for prostate cancer risk management?

Answer 3

Does to recommend mass population screening.

Supports opportunistic screening if patients are counselled.

Question 4

What does it mean that the NHS doesn’t recommend screening?

Answer 4

Discussing PSA test:

• When the present with associated symptoms
• When they come to discuss about a family member who has prostate cancer or because they read about PSA.

But GP should NOT be sending out invites to med to have their PSA checked at a certain age.

Question 5

What are the issues for PSA screening?

Answer 5

Over-diagnosis
Over-treatment
QoL -Co-morbidity of established treatments
Cost-effectiveness

Question 6

What are other causes for raised PSA?

Answer 6

Infection
Inflammation
Large prostate
Urinary retention

Question 7

How do men with prostate cancer present?

Answer 7

Urinary symptoms
Bone pain (metastasis to bone)
Had their PSA checked, then biopsies
DRE for another reason -e.g. change in bowel habit

Incidental finding at transurethral resection of prostate (TURP) for retention / urinary symptoms

Question 8

How do you diagnose a prostate cancer?

Answer 8

DRE / Serum PSA

TRUS (transurethral ultrasound guided biopsy of prostate)

OR

Lower urinary tract symptoms

Transurethral resection of prostate (TURP)

Question 9

What factors influence the treatment decisions?

Answer 9

Age

DRE - localised (T1/T2), Locally advanced (T3), Advanced (T4)

PSA level

Biopsy - Gleason grade, Extent

MRI scan and bone scan - nodal and visceral metastases

Question 10

How do you treat localised prostate cancer?

Answer 10

Established localised:
—Surveillace (unlikely to come to harm form their prostate)

—Robotic radical prostectomy -under 70, at least Gleason 7

—Radiotherapy - External beam, Brachytherapy -65-80, no metastasis and high risk.

Question 11

How do you treat locally advanced prostate cancer?

Answer 11

Surveillace

Hormones

Hormones and radiotherapy

Question 12

How do you treat metastatic prostate cancer?

Answer 12

Hormones (+/- chemotherapy)
-Surgical castration
-Medical castration
—LHRH agonists

Palliative

• Single dose radiotherapy
• Bisphosphonates - Zoledronic acid
• Chemotherapy
• New treatments (e.g. abiraterone, enzalutamide)