Prostate Cancer

Question 1

What is the growth of the prostate influenced by

Answer 1

androgens (testosterone and dihydrotestosterone (DHT)).

Question 2

The majority of prostate cancer is what type and in which zone of the prostate

Answer 2

adenocarcinomas and Over 75% of prostate adenocarcinomas arise from the peripheral zone

Question 3

What are the two types of adenocarcinoma

Answer 3

Acinar - from glandular cells of the prostate

Ductal - from the cells that line the ducts of the prostate

Question 4

what are the risk factors of prostate cancer

Answer 4

Age - men older than 75

Family history

Ethnicity - Afro Caribbean’s

Genetics - BRCA1/2 genes

DM
Smoking

Question 5

what are the clinical features of prostate cancer

Answer 5

LUTS - Weak stream, increased frequency, urgency

More advanced - haematuria, bone pain, anorexia, weight loss

Question 6

What can you feel on a DRE

Answer 6

asymmetry, nodularity, or a fixed irregular mass

Question 7

what are the differential diagnosis

Answer 7

BPH

Prostatitis

Bladder cancer, urinary stones, UTI, pyelonephritis

Question 8

What are the lab tests for prostate cancer

Answer 8

PSA

There are age thresholds for PSA as PSA naturally goes up with age

Question 9

How can PSA become falsely elevated

Answer 9

BPH, prostatitis, vigorous exercise, ejaculation

Question 10

How are biopsies of the prostate taken

Answer 10

TRUS - transrectal ultrasound guided biopsy

Transperineal biopsy

Question 11

What is Involved in TRUS

Answer 11

12 cores are taken bilaterally in equal distribution from base to apex

Question 12

What is the Gleason score

Answer 12

The Gleason grading system is a scoring system by which prostate cancers are graded, based upon their histological appearance.

Question 13

how is the Gleason score calculated

Answer 13

Gleason Score is then calculated as the sum of the most common growth pattern + the second most common growth pattern seen.

Question 14

What is mp-MRI

Answer 14

Used to aid the diagnosis of prostate cancer as it highlights the areas of abnormal cells - this is often done before biopsies

Question 15

What imaging is used to stage prostate cancer

Answer 15

CT CAP

Question 16

What is low risk prostate cancer

Answer 16

Gleason score of 6 or below

Question 17

What is the treatment of low risk cancer

Answer 17

Active surveillance

Question 18

What is the intermediate risk

Answer 18

Gleason score of 7

Question 19

Treatment of intermediate

Answer 19

Active surveillance/ radical options can be discussed

Question 20

What is high risk cancer

Answer 20

Gleason score of 8 and above

Question 21

What is the treatment for high risk cancer

Answer 21

Radical prostatectomy

Question 22

What is the treatment for metastatic disease

Answer 22

Chemotherapy and anti-hormonal agents

Anti-hormonal:
Bicalutamide (Testosterone receptor antagonist) for 28days —

LHRH analogue injection ( eg - goserelin ) after 14 days – repeated every
month (3 month/6 month dose when stable)

Chemotherapy:
Docetaxel

Question 23

what is the definition of castrate resistant prostate cancer

Answer 23

Prostate cancer that keeps growing even when the amount of testosterone in the body is reduced to very low levels

Question 24

How do you treat castrate-resistant prostate cancer

Answer 24

Add bicalutamide back in
(Maximum Androgen Blockade) — Dexamethasone — Docetaxel chemotherapy —
Abiraterone/Enzalutamide
— Palliative Care

Question 25

What is watchful waiting

Answer 25

Watchful waiting is a symptom-guided approach to prostate cancer management where definitive therapy is often deferred and hormonal therapy is initiated at time of symptomatic disease

Offered to older patients with lower life expectancy- aim is not to cure

Question 26

what is active surveillance

Answer 26

Active surveillance can be offered to select patients with low-risk disease and for some cases of intermediate-risk disease. Active surveillance requires monitoring of patients with 3-monthly PSA, 6 month to yearly DRE, and re-biopsy at 1-3 yearly intervals assessing for progression and intervening at the appropriate time.

Question 27

What is the surgical management for prostate cancer

Answer 27

Radical prostatectomy

removal of the prostate gland, resection of the seminal vesicles, along with the surrounding tissue +/- dissection of the pelvic lymph nodes.

Question 28

what are the side effects of radical prostatectomy

Answer 28

erectile dysfunction
stress incontinence
bladder neck stenosis

Question 29

what is brachytherapy

Answer 29

transperineal implantation of radioactive seeds (usually Iodine-125) directly into the prostate gland

Question 30

What is external beam therapy

Answer 30

focused radiotherapy to target the prostate gland