Prostate Cancer

Question 1

Give 4 risk factors for prostate cancer

Answer 1

Increasing age
Family history (if onset <60 years)
BRCA 1+2 genes
African-American

Question 2

What type of cancers are 95% of prostate cancers?

Answer 2

Adenoarcinomas

Question 3

How do prostate cancers present?

Answer 3

Asymptomatic- incidental finding of raised PSA
Obstructive lower urinary tract symptoms --> weak urinary flow, dribbling, frequency 
Nocturia 
Feeling of full bladder
Retention 
Haematuria 
Weight loss 
Bone pain --> advanced disease

Question 4

What is found on DRE in a patient with prostate cancer?

Answer 4

Hard, craggy, enlarged prostate

Question 5

Give 4 causes of a raised PSA

Answer 5

Prostate cancer
UTI 
Benign prostatic hypertrophy 
Urinary retention 
Recent DRE 
Prostatitis

Question 6

What investigations can be done to diagnose prostate cancer?

Answer 6

PSA blood test
TRUS biopsy
MRI prostate
Isotope bone scan

Question 7

What scoring system is used for prostate cancer?

Answer 7

Gleason Score- biopsy samples graded 1-5 with 5 being anaplastic. 2 worst areas biopsied added together to give score out of 10. <6 = low grade cancer, 8-10= high grade, aggressive cancer

Question 8

How is prostate cancer actively managed?

Answer 8

Radical prostatectomy –> removal of prostate
Radical radiotherapy
Brachytherapy –> implant radioactive seeds into prostate

Question 9

When is active surveillance used to manage prostate cancer?

Answer 9

Aged >70 years old with low risk cancer. Unnecessary to do excessive curative treatment. Repeat MRI and check PSA every 2 years

Question 10

How can advanced prostate cancer be managed?

Answer 10

Surgical castration –> reduces androgens
Medical castration –> LHRH agonist
Androgen antagonist

Question 11

Why is prostate cancer screening not currently recommended?

Answer 11

PSA creates false positives
High cost to biopsy all false positives
PSA creates false negatives
No improvement to mortality if screened