Prostate cancer

Question 1

How many men will be diagnosed with prostate cancer in their lifetime?

Answer 1

1/8

Question 2

What type of hormone affects the growth of prostate cancer?

Answer 2

Androgens

Question 3

What type of cancer are prostate cancer usually?

Answer 3

Adenocarcinomas

Question 4

Where is the prostate does cancer usually develop?

Answer 4

Peripheral zone

Question 5

Prostate cancer is usually multifocal, what does this mean?

Answer 5

Arising from two or more places

Question 6

What are the two types of adenocarcinoma of the prostate?

Answer 6

Acinar adenocarcinoma and Ductal adenocarcinoma

Question 7

What is a acinar adenocarcinoma?

Answer 7

originated in the glandular cells that line the prostate gland- most common

Question 8

What is a ductal adenocarcinoma?

Answer 8

Originates in the cells that line the ducts of the prostate gland- tends to metastasise faster

Question 9

What are the risk factors for prostate cancer?

Answer 9

Age, Black African or Caribbean, Family history, BRACA2 or 1, obesity, diabetes, smoking, less exercise

Question 10

What are the clinical features of prostate cancer?

Answer 10

LUTS
Haematuria, dysuria, incontinence, haematospermia, suprapubic pain, loin pain, rectal tenesmus, bone pain, lethargy, anorexia, unexplained weight loss

Question 11

What examination is essential in the diagnosis of prostate cancer?

Answer 11

DRE as most cancers arise from the posterior peripheral zone, looking for asymmetry, modularity, fixed irregular mass

Question 12

What are the differential diagnosis for prostate cancer?

Answer 12

BPH, Prostatitis, bladder cancer, urinary cancer, urinary stones, UTI, pyelonephritis

Question 13

What antigen would you test for?

Answer 13

Prostate specific antigen

Question 14

Other than prostate cancer what can raise PSA?

Answer 14

BPH, Prostatitis, vigorous exercise, ejaculation, recent DRE

Question 15

What calculations can be done with a PSA?

Answer 15

Free:total PSA ratio, if low then more likely to be prostate cancer, also PSA density (serum PSA/prostate volume) higher will mean more likely cancer

Question 16

Why is prostate screening not offered?

Answer 16

Over diagnosis and over treatment is a concern

Question 17

What is the current standard method for diagnosing prostate cancer?

Answer 17

Transperineal biopsy and transracial ultrasound guided biopsy

Question 18

What is a transperineal biopsy?

Answer 18

Sampling prostatic tissue transperineally in a systematic manner, usually under general anaesthetic, allows better access to the anterior part of the prostate and had a lower risk of infection

Question 19

What is a transracial ultrasound guided biopsy?

Answer 19

(TRUS) sampling transrectally, under local anaethetic, 12 cores are taken bilaterally in equal distribution from base to apex, 1-2% chance of sepsis

Question 20

When should repeat biopsies be done?

Answer 20

after negative biopsy but still rising or persistent elevated PSA, if have small acinar proliferation or three sites of High grade prostatic intraepithelial neoplasia or atypical glands

Question 21

What is the gleason grading system?

Answer 21

Scoring system by which prostate cancers are graded based on their histological appearance, assigned a score based on most common and second most common growth pattern, lowest= 3+3, higher the score the worse prognosis

Question 22

What imaging can be done for prostate cancer?

Answer 22

Multi-parametric magnetic resonance imaging as identify abnormal areas of the prostate which are then targeted for biopsy by MRI-ultrasound fusion, staging by abdomen-peliv CT imagine and a bone scan

Question 23

What is the management for prostate cancer?

Answer 23

discussed at an MDT, depends on stage of disease

Question 24

What is watchful waiting?

Answer 24

symptom guided approach where definitive therapy is deferred and hormonal therapy is initiated at time of symptoms, used for older patients with lower life expectancy

Question 25

What is active surveillance?

Answer 25

monitor patient every 3 months PSA, DREs every 6months- year and re biopsy 1-3 years assessing progression and intervening at an appropriate time

Question 26

What is the surgical management for prostate cancer?

Answer 26

Radical prostatectomy- removal of prostate and resection of the seminal vesicles and surrounding tissue with possible dissection of the pelvic lymph nodes, erectile dysfunction, stress incontinence and bladder neck stenosis are common side effects

Question 27

What other treatment is there for prostate cancer?

Answer 27

Radiotherapy and brachytherapy, chemotherapy and anti-androgen therapy (LHRH agonists, GnRH receptor agonists)