Prostate Cancer

Question 1

Features of prostate cancer

Answer 1

• Most common cancer in men
• Risk increases with age
• Other risk factors include family history, being black, being tall and use of anabolic steroids
• Presentation is similar to BPH but can also include haematuria, erectile dysfunction and general signs of cancer and metastasis (i.e. weight loss, fatigue and bone pain)
• Staged using the TNM system

Question 2

Diagnosis of prostate cancer

Answer 2

• PSA
• Not very sensitive or specific, more useful for monitoring progression of disease
• Prostate Examination
  
  • Benign prostate feels smooth, symmetrical and slightly soft with a maintained central sulcus
  • Cancerous prostate may feel firm/hard, asymmetrical, craggy or irregular with loss of the central sulcus
• Prostate Biopsy
  
  • Definitive method for diagnosing prostate cancer but not particularly sensitive because cancers may be located in areas not biopsied
  • Multiple needle biopsies are taken to minimize risk of missing the cancer.
  • Can be Transrectal Ultrasound-Guided Biopsy (TRUS) or transperineal.

Question 3

Management of prostate cancer

Answer 3

• Graded using the Gleason Grading System
• 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
    
    • Bilateral orchidectomy is the gold standard hormonal treatment
    • LHRH agonists cause chemical castration (i.e. goserelin)
    • Androgen receptor blockers (i.e. bicalutamide)
• Surgery in the form of total prostatectomy