Prostate Cancer

Question 1

Adeno - Carcinoma

Answer 1

Adeno = Gland 
Carcinoma = uncontrolled growth of cells

Question 2

What are the two zones of the prostate and what do they make up?

Answer 2

Central zone - Ejaculatory ducts and 25% of glandular tissue.
Peripheral zone - 70% of glandular tissue.
Transitional zone - Portion of the prostatic urethra and 5% of glandular tissue.

Question 3

What abnormality occurs in the transitional zone of the prostate in older men?

Answer 3

Hyperplasia - (benign prostatic hyperplasia)

Question 4

What does hyperplasia of the transitional zone of the prostate cause?

Answer 4

Compression of the prostatic urethra.

Question 5

What do luminal cells of the prostate do?

Answer 5

Secrete substances into prostatic fluid to make it alkaline, give nutrients for swim and help them survive in the acidic vagina.

Question 6

PSA is produced by what cells of the prostate?

Answer 6

Luminal cells

Question 7

How is DHT made?

Answer 7

DHT is made by the prostate from testosterone.

Question 8

What are the risk factors of prostate adenocarcinoma?

Answer 8

Old age
Obesity
High fat/Low fibre diet

Question 9

Why does early prostate cancer usually display no symptoms?

Answer 9

Early prostate cancer most commonly develops in the posterior peripheral zone away from the urethra. Therefore the tumours can grow quite large before they cause problems with urination.

Question 10

If the prostate cancer does compress the bladder/urethra, what symptoms may be seen?

Answer 10

Difficulty urinating
Bleeding
Pain with urinating/ejaculating

Question 11

What is the treatment plan for non-metastatic prostate cancer?

Answer 11

Active surveillance - PSA levels measure and imaging to ensure cancer has stayed confined to the prostate.

Question 12

What are the treatment options for metastatic cancer?

Answer 12

Surgery
Radiation therapy
Chemotherapy
Hormonal therapy

Question 13

Where is the most common site of metastasis of prostate cancer?

Answer 13

Bone

Question 14

How does prostate cancer spread to bone?

Answer 14

It can be by direct invasion or by travelling through your blood or lymphatic system.

Question 15

In cases of metastasis of prostate cancer what is the presentation.

Answer 15

Symptoms of prostate cancer along with back ache.

Question 16

What is tested in screening of prostate cancer?

Answer 16

Serum PSA

DRE in some cases

Question 17

DRE

Answer 17

Digital rectal examination

Question 18

What is the function of PSA?

Answer 18

PSA is produced by the prostate, it’s function is to liquefy the ejaculate, enabling fertilisation.

Question 19

Testosterone is converted to DHT (dihydrotestosterone) by what enzyme?

Answer 19

5alpha-reductase

Question 20

Why do DHT levels increase with age?

Answer 20

Although testosterone levels decrease with age, 5alpha reductase levels increase. Therefore there are increased levels of DHT.

Question 21

What is the effect of increased DHT levels on the prostate?

Answer 21

Increased cell division of cells of the prostate.

Question 22

Why is BPH not malignant?

Answer 22

BPH does not increase the risk of developing mutations that lead to prostate cancer.

Question 23

How does BPH present?

Answer 23

Urethral obstruction which in turn causes bladder hypertrophy.

Question 24

How is BPH diagnosed?

Answer 24

DRE and serum PSA levels.

Biopsy carried out to test malignancy.

Question 25

What is the treatment of BPH?

Answer 25

Finasteride

Surgery

Question 26

What does finasteride do?

Answer 26

Finasteride inhibits 5alpha-reductase preventing DHT formation.

Question 27

What are the symptoms of BPH?

Answer 27

Urinary hesitancy 
Nocturia
Dribbling
Dysuria
Feeling of bladder fullness

Question 28

How do you diagnose is a prostate cancer has metastasised?

Answer 28

Bone scan MRI