Prostate cancer

Question 1

Most common type

Answer 1

Prostate adenocarcinoma

Question 2

Clinical features

Answer 2

Asymptomatic LUTS - hesitancy, frequency

Metastatic disease may present as bone pain.

Locally advanced disease may present as pelvic pain or with urinary symptoms.

Question 3

Investigations

Answer 3

DRE - craggy or assymmetrically enlarged prostate in peripheral zone

Bloods: PSA

Imaging: CT or MRI to stage

Trans rectal USS plus biopsy to grade

Question 4

Management

Answer 4

• Watch and wait if old+ many co-morbidities + low gleason score
• Active surveillance (at least 10 core biopsy + at least one rebiopsy with radical treatment if any abnormalities found) if:

Gleason score 3+3, stage T1c, cancer in less than 50% of their biopsies etc.

RADICAL THERAPY

• Radiotherapy directed at the prostate: palliative and Brachytherapy: Radioactive seeds implanted into the prostate
• Hormonal treatment (antiandrogen therapy): block testosteron and slow or stop prostate cancer growth

Side effects include hot flushes, sexual dysfunction, gynaecomastia, fatigue and osteoporosis

Options:

i) Bilateral orchidectomy is the old way
ii) LHRH agonists cause chemical castration (e.g. goserelin)
iii) Androgen receptor blockers (e.g. bicalutamide)
- Surgery in the form of total prostatectomy (commonly now robotic laparoscopic prostatectomy) for localised disease

Question 5

Gleason Score

Answer 5

Graded using the Gleason grading system with two grades awarded:

• 1 for most dominant grade (on scale of 1-5)
• 2 for second most dominant grade (scale 1-5)

The two added together give the Gleason score.

Where 2 is best prognosis and 10 the worst.