Prostate Cancer

Question 1

RF

Answer 1

• Risk increases with age

* Other risk factors include family history, being black, being tall and use of anabolic steroids

Question 2

Presentation

Answer 2

•Presentation is similar to BPH but can also include haematuria, erectile dysfunction and general signs of cancer and metastasis (e.g. weight loss, fatigue and bone pain

Question 3

What is PSA?

Answer 3

• Not very sensitive or specific (positive and negative results are unreliable)
• Most useful in monitoring the progression of the disease and success of treatment

Question 4

Normal vs Abnormal PR exam findings

Answer 4

• A benign prostate feels smooth, symmetrical and slightly soft with a maintained central sulcus
• A cancerous prostate may feel firm/hard, asymmetrical, craggy or irregular with loss of the central sulcus

Question 5

How to diagnose?

Answer 5

• The definitive method for diagnosing prostate cancer
• Still not particularly sensitive because cancers may be located in areas not biopsied
• Multiple needle biopsies are taken to minimize risk of missing the cancer

Question 6

What types of biopsy are there?

Answer 6

◦Transrectal Ultrasound-Guided Biopsy (TRUS) ◾Ultrasound inserted into rectum and a needle biopsy taken through rectal wall into prostate under US guidance
◾Usually around 10 biopsies are taken to try and pick up the cancer

◦Transperineal
◾This method allow more biopsies to be taken (around 35)
◾This has a higher sensitivity than TRUS
◾It takes longer than TRUS and requires general anaesthetic

Question 7

Managing prostate cancer

Answer 7

• Watchful waiting in early prostate cancer
• Radiotherapy directed at the prostate
• Brachytherapy

◦Radioactive seeds implanted into the prostate
◦Deliver continuous, targeted radiotherapy to the prostate

•Hormonal treatment (antiandrogen therapy)

◦Prostate tissue grows in response to androgens like testosterone
◦Hormonal therapy aims to block androgens and slow or stop prostate cancer growth
◦Side effects include hot flushes, sexual dysfunction, gynaecomastia, fatigue and osteoporosis

•Surgery in the form of total prostatectomy

Question 8

What hormonal therapy options are there?

Answer 8

• ◦ 1.Bilateral orchidectomy is the gold standard hormonal treatment

2. LHRH agonists cause chemical castration (e.g. goserelin)
3. Androgen receptor blockers (e.g. bicalutamide)

Question 9

Complications of Radical Treatment with Prostatectomy and Radiotherapy

Answer 9

• Erectile dysfunction
• Urinary incontinence
• Radiation induced enteropathy (giving gastrointestinal symptoms like PR bleeding, pain, incontinence etc)
• Urethral strictures