Prostate Cancer

Question 1

What are risk factors for prostate cancer

Answer 1

Increasing age
Obesity
Afro-Caribbean
Famile history

Question 2

What are clinical features of prostate cancer?

Answer 2

Asymptomatic - cancers tend to develop in peripheral prostate so don’t cause obstructive symptoms early

Bladder outlet obstruction: Hesitancy, urinary retention
Poor stream
Terminal dribbline
Haematuria
Haematospermia
Pain: back, perineal, testicular

Weight loss and bone pain suggests mets

DRE: asymmetrical, hard, nodular enlargement with loss of median sulcus craggy

Question 3

How is prostate cancer diagnosed?

Answer 3

PSA measurement
DRE
Trans-rectal USS guided biopsy
MRI/CT for staging

Question 4

What is histology of prostate cancer?

Answer 4

Adenocarcinoma of the peripheral zone

Question 5

How is prostate cancer staged?

Answer 5

MRI/CT

TNM

Question 6

What can raise the PSA?

Answer 6

BPH
Prostatitis and UTI
Ejaculation (ideally not in previous 48h)
Vigorous exercise (ideally not in previous 48h)
Urinary retention
Instrumentation of urinary tract

Question 7

How localised prostate cancer managed?

Answer 7

Conservative: active surveillance (regular PSA) and watchful waiting (wait for symptoms)
Radical prostatectomy
Radiotherapy: external beam and brachytherapy

Question 8

How is localised advanced prostate cancer managed?

Answer 8

Hormonal therapy:
GnRH agonist - Goserelin
Anti-androgen - cyproterone acetate prevents DHT binding from intracytoplasmic protein complexes

Radical prostatectomy
Radiotherapy

Question 9

How is metastatic prostate cancer managed?

Answer 9

Horomnal therapy
Anti-androgen cyproterone aceteate
Orchidectomy

Question 10

How is prostate cancer prognosis assessed? How does it spread

Answer 10

Gleason grading system
2 grades awarded for most dominant grade (1-5) and second most dominant grade (1-5) and added

Lymphatic spread first to obturator nodes and local extra prostatic spread to the seminal vesicles

Question 11

What advice should be given to asymptomatic man asking for PSA test?

Answer 11

Test is not very accurate
If test is falsely positive - may needlessly have more tests
Only one in three of those with high PSA may have cancer
Worried needlessly if alter tests are clear
IF cancer found, no way to tell if it will impinge on health
Treatment may cause more bad effects

Question 12

Who should be referred for 2WW assessment?

Answer 12

Men aged 50-69 should be referred if PSA is >= 3 or there is abnormal DRE