Prostate Cancer

Question 1

What is prostate cancer?

Answer 1

A malignant tumour of glandular origin, situated in the prostate.

Question 2

A typical patient with prostate cancer

Answer 2

Most commonly seen in older men
Uncommon in men aged under 50 years.
The median age at diagnosis in the US is 66 years.

Question 3

Gold standard treatment for prostate cancer

Answer 3

PSA and DRE are key diagnostic tools used in screening.

Question 4

Aetiology of prostate cancer

Answer 4

No. of aetiological factors have been suggested:
High-fat diet
Genetic factors

Question 5

Pathophysiology of prostate cancer

Answer 5

High-grade prostatic intraepithelial neoplasia (PIN) is considered to be the most likely precursor of invasive prostate cancer.
Prostate cancer tends to spread along the capsular surface of the gland.

Question 6

Diagnosis of prostate cancer

Answer 6

Routine screening with DRE and PSA.
Alternatively, patients may present with signs and symptoms of urological obstruction.
A prostate biopsy (using a TRUS-guided needle biopsy) confirms the diagnosis and aids grading.
Staging is determined using imaging studies and biopsies when indicated.

Question 7

What are the systemic symptoms of malignancy?

Answer 7

Weight loss 
Anorexia 
Bone pain
Lethargy 
Palpable lymph nodes

Question 8

What is the Gleason score?

Answer 8

The Gleason score is used to grade prostate tumours obtained from a biopsy.
A biopsy-positive specimen is given a score from 1 to 5 based on the degree of architectural differentiation of the tumour.
The Gleason score is obtained by assigning a primary grade to the predominant grade present and a secondary grade to the second most prevalent grade; for example, a tumour with grade 3 and grade 2 cells equates to a Gleason score of 5. Gleason scores under 6 are rarely recorded in contemporary cases.
Low-grade tumour: Gleason score ≤6
Intermediate-grade tumour: Gleason score 7
High-grade tumour: Gleason score 8 to 10

Question 9

Signs and symptoms of prostate cancer

Answer 9

Nocturia
Urinary frequency (uncommon in low-risk)
Urinary hesitancy (uncommon in low-risk)
Dysuria (uncommon in low-risk)
Abnormal DRE

Question 10

Risk factors for prostate cancer

Answer 10

Age > 50 years
Black ethnicity 
North American or northwest European descent 
FHx of prostate cancer
High levels of dietary fat

Question 11

Investigations of prostate cancer

Answer 11

PSA (increased) 
Testosterone (normal) 
LFTs (normal) 
FBC (normal) 
Renal function (normal except if there is obstruction) 
Biopsy (TRUS biopsy)
Bone scan 
Plain x-rays 
Pelvic CT scan

Question 12

Differentials of prostate cancer

Answer 12

BPH

Chronic prostatitis

Question 13

What is used to grade prostate cancer?

Answer 13

Gleason score

Question 14

Management of prostate cancer

Answer 14

Treatment may consist of: 
Observation 
Active surveillance 
Androgen deprivation therapy 
External-beam radiotherapy 
Brachytherapy 
Radical prostatectomy 
Treatment decision depends on: 
Patient's risk group 
Patient's projected survival 
Patient's preference (side effects of treatment vs living with cancer)

Question 15

Primary prevention of prostate cancer

Answer 15

25% risk reduction of prostate cancer in men treated with 5 alpha-reductase- inhibitor (5-ARI) finasteride

Question 16

Complications of prostate cancer

Answer 16

Most complications occur with treatment and it includes: 
Radiation-induced: 
Dysuria 
Frequency 
Urinary incontinence 
Urinary urgency 
Nocturia 
Diarrhoea