Prostate Cancer

Question 1

What do you use to grade prostate cancer?

Answer 1

Gleason score - find biggest tumour to do this

Question 2

What is the most common type of prostate cancer?

Answer 2

Adenocarcinoma

Question 3

What are risk factors for prostate cancer?

Answer 3

• Obesity
• Afro-Caribbean
• Genetic (BRCA1/2)
• FH
• Age > 50

Question 4

If prostate cancer causes symptoms, what are they?

Answer 4

LUTS

• Nocturia
• Poor stream
• Hesitancy
• Dysuria
• Increased frequency
• Systemic symptoms - weight loss, lethargy

Question 5

What is the main symptom of metastatic prostate cancer?

Answer 5

Bone pain e.g. lumbar back pain - spinal mets/external compression

Question 6

What is a treatment-related complication of prostate cancer?

Answer 6

Post-operative sexual dysfunction

Question 7

What is the first line investigation for prostate cancer?

Answer 7

DRE

Question 8

What blood test might you do for prostate cancer?

Answer 8

Serum PSA (raised - non-specific) > 4

Question 9

How do you diagnose prostate cancer?

Answer 9

Transrectal US + biopsy (TRUS biopsy) - transrectal US-guided needle biopsy

Question 10

What other investigations might you do for prostate cancer?

Answer 10

• Bone scan ± X ray - mets
• Pelvic MRI
• Staging - CT/MRI AP

Question 11

What is the curative treatment for prostate cancer?

Answer 11

• Active surveillance
• Surgery (radical prostatectomy)
• Radical radiotherapy
• ± hormone therapy

Question 12

What is palliative treatment for prostate cancer?

Answer 12

• Watchful waiting

- Hormone therapy

Question 13

What hormone therapy can you give in (palliative) prostate cancer?

Answer 13

Androgen deprivation

• LHRH agonists/antagonists
• Anti-androgens

Question 14

Why do you treat palliative prostate cancer with androgen deprivation?

Answer 14

Androgens promote growth of prostate cells (cancer + normal) so want to slow this down

Question 15

What would you find on DRE/PR exam in prostate cancer?

Answer 15

Asymmetrical nodular mass (craggy mass)

anal tone

Question 16

What type of lymphadenopathy does prostate cancer cause?

Answer 16

Non-tender inguinal lymphadenopathy

Question 17

What medication is used to treat BPH?

Answer 17

Tamsulosin

Question 18

What is the most common cancer diagnosed in men in the UK?

Answer 18

Prostate cancer

Question 19

What are some complications of treatment for prostate cancer?

Answer 19

• Radiation-induced urinary symptoms
• Surgery-induced urinary symptoms and altered sexual function
• Hormone-induced (gynaecomastia, hot flushes, ED)

Question 20

What are signs suggestive of mets in prostate cancer?

Answer 20

• Lumbar back pain

- Non-tender inguinal lymphadenopathy

Question 21

What can you not do before having PSA measured?

Answer 21

No ejaculation 24h before checking PSA (can be raised)

Question 22

What other blood tests can you do in prostate cancer?

Answer 22

• Testosterone
• LFTs
• FBC
• Renal function - if low don’t use contrast

Question 23

How do you manage localised prostate cancer?

Answer 23

• Active surveillance (PSA every 3-4 months + PR exam at 12 months + MRI at 12-18 months)
• Radical prostatectomy (robotic)
• Radical radiotherapy/external beam radiotherapy
• Brachytherapy
• Androgen-deprivation therapy (LHRHa)
• Watchful waiting