Prostate cancer

Question 1

Define prostate cancer

Answer 1

A primary malignant neoplasm of glandular origin, situated in the prostate

Question 2

Describe the typical location, type and spread of prostate cancer

Answer 2

• Most are adenocarcinomas
• Arise in the peripheral prostate
• Spread may be:
  
  • local (seminal vesicles, bladder, rectum)
  • via lymph or haematogenously (sclerotic bony lesions)

Question 3

Explain the risk factors of pancreatic cancer

Answer 3

• age over 50 years
• afro-caribbean ethnicity
• positive family history of prostate cancer- inc risk 2-3x
• Dietary factors
• Occupational exposure to cadmium
• Raised testosterone

Question 4

Summarise the epidemiology of prostate cancer

Answer 4

• commonest cancer in males
• 2nd most common cause of male cancer deaths

Question 5

Recognise the presenting symptoms of prostate cancer

Answer 5

Often asymptomatic- patients present following routine screening with DRE and PSA

May be urinary symptoms- not very common in low-risk disease. If present, may be an indication of higher T-stage or benign prostatic hyperplasia.:

• nocturia
• urinary frequency
• urinary hesitancy
• dysuria

Signs of metastatic spread:

• Metastatic Spread
• Bone pain
• Cord compression
• Systemic symptoms: malaise, anorexia, weight loss
• Paraneoplastic syndromes (e.g. hypercalcaemia)

Question 6

Recognise the signs of prostate cancer on physical examination

Answer 6

• Asymmetrical hard nodular prostate – DRE exam
• Loss of midline sulcus
• Palpable lymph nodes (if metastasised)

Question 7

Identify appropriate investigations for prostate cancer

Answer 7

First line: serum PSA

• the vast majority of those with a raised PSA will not have prostate cancer- not very specific
• other non-malignant conditions (e.g., prostatitis and benign prostatic hyperplasia) may also increase PSA levels.

2: FBC, LFTs, renal function- normal, except for locally advanced disease causing obstruction and/or anaemia

3: DRE

4: Transrectal ultrasound-guided biopsy (TRUS)- used to confirm diagnosis and aid grading.

5: Isotope bone scan to check for bone metastases- low risk of osseous metastasis unless PSA>20 micrograms/L

6: Pelvic CT: to evaluate the prostate size and to assess for the presence of enlarged pelvic lymph nodes.

Question 8

Prognosis of prostate cancer?

Answer 8

Prostate cancer is very common (60% of men >80 years),

usually asymptomatic (90% of cases), and

usually not fatal (75% of cases)