what type of cancer is most prevalent?
adenocarcinoma of peripheral zone
epidemiology?
most common cancer in men
risk factors?
- FH
- black
- being tall
- use of anabolic steroids
presentation?
similar to BPH but can also include
- haematuria
- erectile dysfunction
- general signs of cancer ie wt loss
- signs of metastasis ie bone pain
What is investigation & therefore diagnosis of prostate cancer?
- PSA - not v sensitive or specific
- digital rectal examination
- TRUS-guided prostate biopsy
what do a benign / cancerous prostate feel like on DRE?
benign- smooth, symmetrical and slightly soft w/ a maintained central sulcus (tip of nose)
cancerous- hard, craggy / irregular, asymmetrical w loss of central sulcus
How is prostate cancer graded?
Gleason Grading System
- higher the grade, worse the prognosis
Grade 1- well differentiated cancer
Grade 2- moderately differentiated cancer
Grade 3- moderately differentiated cancer
Grade 4- poorly differentiated cancer
Grade 5- anaplastic
where is lymph node spread for prostate cancer?
pelvic lymph nodes
what is treatment for
- localised prostate cancer
- locally advanced prostate cancer
l_ocalised (low risk)_
- watchful waiting/ active surveillance
localised (intermediate - high risk)
- radiotherapy
- radical prostatectomy
locally advanced
- Brachytherapy
- radioactive seeds implanted into prostate
- deliver continuous, targeted radiotherapy to prostate
- Hormonal therapy
- +/- surgery or radiation
what is hormonal therapy and how does it work?
works by blocking androgens & in doing so, slowing or stopping prostate cancer growth
options:
- bilateral orchidectomy- gold standard
- LHRH agonists eg goserelin
- androgen receptor blockers
S/E of hormonal therapy?
- hot flushes
- sexual dysfunction
- gynaecomastia
- osteoporosis
complications of radical treatment w prostatectomy
- urethral strictures
- erectile dysfunction
- urinary incontinence
