Prostate Cancer

Question 1

PSA

Answer 1

Done prior to a digital rectal exam to avoid stimulating release of PSA

not very specific or sensitivity. positive or negative results are not very reliable.

Question 2

Risk factors

Answer 2

age
family hx
black, tall
use of anabolic steroids

Question 3

symptoms of prostate cancer

Answer 3

can present similarly to BPH
haematuria
erectile dysfunction
general signs of cancer/mets e.g weight loss, fatigue, bone pain

Question 4

DRE prostate exam

Answer 4

benign prostate- smooth, symmetrical soft with maintained central sulcus

cancerous prostate- firm/hard, asymmetrical, craggy, irregular with loss of central sulcus

Question 5

Prostate cancer investigations

Answer 5

1. DRE
2. Prostate Biopsy. not particularly sensitive as some cancerous may be located in areas that are not biopsied. multiple needles are therefore taken to minimize risk of missing the cancer.

• TRUS (transrectal ultrasound guided biopsy) insert needle into rectum and a needle biopsy through rectal wall into prostate under US guidance. 10 biopsies
• transperineal
  allows around 35 biopsies to be taken. higher sensitivity.

Question 6

Gleason Grading System

Answer 6

specific to prostate cancer
helps determine if tx is appropriate

Grade 1: Well differentiated cancer.
Grade 2: Moderately differentiated cancer.
Grade 3: Moderately differentiated cancer.
Grade 4: Poorly differentiated cancer.
Grade 5: Anaplastic (poorly differentiated) cancer.

Question 7

prostate cancer management

Answer 7

1. watchful waiting
2. radiotherapy at the prostate
3. brachytherapy- radioactive seeds implanted into the prostate. deliver continuous targeted radiotherapy at the prostate
4. hormonal treatment (antiandorgen therapy) prostate tissue grows in response to androgen like testosterone so hormonal therapy blocks androgens to slow/stop prostate growth. side effects= hot flushes, sexual dysfunction, gynaecomastia, fatigue, osteoporosis.

• bilateral orchidectomy (gold standard)
• LHRH agonist chemical -castration (gosorelin)
• androgen receptor blocker (bicalumatide)

surgery- total prostatectomy.

Question 8

complications of treatment

Answer 8

Erectile dysfunction
Urinary incontinence
Radiation induced enteropathy (giving gastrointestinal symptoms like PR bleeding, pain, incontinence etc)
Urethral strictures