Prostate Cancer

Question 1

prostate cancer

Answer 1

• common cancer (3rd leading CA resulting in death)
• aggressive if develops in young men
• risk factor = ageing (85% occurs in men after age 65)
• no early mnftns so dx is delayed

Question 2

where does the cancer arise?

Answer 2

• peripheral subcapsular CA -> develops immediately below the capsule lining the prostate
• d/t peripheral development, it won’t cause the same compression on urethra and same mnftns as BPH

Question 3

risks

Answer 3

• age (cumulative exposure to antigens)
• diet and ethnicity
• familial
• androgens (male sex hormones that support growth and fx of prostate, as well as growth of malignant CA cells)

Question 4

patho

Answer 4

• ~98% are adenocarcinomas
• arises peripherally and is multicentric (can arise in >1 site = more difficult to treat)
• varied forms
• younger individuals can develop prostate CA (aggressive)
• malignancy is locally invasive and spreads through extension (bladder neck and seminal vesicle)
• mets: spreads to lymph nodes (proximal mets), lung, liver, bones (distal)

Question 5

manifestations

Answer 5

• late (appear after invasion or mets)
• earliest presentations: dysuria or hematuria
• prostatitis
• lower back pain (late - mets to bone)

Question 6

diagnosis

Answer 6

• Hx, Px
• DRE
• PSA (proPSA and Kallikrein are newer markers that enhance value of PSA)
• transurethral US
• biopsy

Question 7

treatment

Answer 7

• largely dependent on stage, grade, age
• localized malignancy = low risk = active surveillance (n treatment)
• 1st line therapy = antiandrogens
• sx = radical prostatectomy (done if detected early)
• radiation

Question 8

antiandrogens

Answer 8

estrogen
limitation: inhibiting proliferation of cells but not curing CA
can’t use it on its own