Prostate cancer

Question 1

What are types of prostate cancer?

Answer 1

Primary acinar adenocarcinoma (most common): glandular cells

Ductal adenocarcinoma: cells lining ducts of prostate gland.

Question 2

What are risk factors for prostate cancer?

Answer 2

Age > 65
FH
5 alpha reductase deficiency
BRCA1/2

Question 3

What are Sx of prostate cancer?

Answer 3

LUTS: nocturia, frequency, hesitancy, incomplete emptying, urgency..

Haematuria

Urinary retention can occur.

Met: bone pain, renal failure, weight loss

Question 4

What are DDx for prostate cancer?

Answer 4

BPH
Prostatitis
other causes of haematuria e.g. bladder cancer, RCC

Question 5

What Ix in prostate cancer?

Answer 5

DRE: mass with asymmetry, nodularity, irregular

PSA: increased

TRUS guided biopsy: get histology.

Isotope bone scan: mets

Pelvic MRI: extension, lymphadenopathy

Question 6

What system used to grade prostate cancers?

Answer 6

Gleason. Prognostic.

Question 7

What is Rx of prostate cancer?

Answer 7

Depends on Gleason score, PSA, and stage.

Low risk: active surveillance + watchful waiting, androgen deprivation

Medium/high risk: radical prostatectomy, radio

Mets: chemo, hormonal therapies, symptom relief

Question 8

What is Rx of low risk prostate cancer?

Answer 8

Active surveillance: 3 monthly PSA, 6 monthly DRE, re-biopsy every 1-3 years.

Watchful waiting: symptom guided.

Can give androgen deprivation: LNRH agonist/antagonist or bilateral orchidectomy.

Question 9

What is Rx in medium/high risk localised prostate cancer?

Answer 9

Prostatectomy: removal of the prostate gland, resection of the seminal vesicles, along with the surrounding tissue +/- dissection of the pelvic lymph nodes

Radio: external beam.
.

Question 10

What are SE of prostatectomy?

Answer 10

erectile dysfunction (affecting 60-90% of men), stress incontinence and bladder neck stenosis.

Question 11

What is Rx in metastatic prostate cancer?

Answer 11

Chemo

LNRH analogues + anti-androgen

TURP to relieve sumptms.

Bisphosphonates and radio for bone pain

Question 12

What is Rx for locally advanced disesae?

Answer 12

Can’t do surgery as it’s incurable, so Rx is palliative.

LNRH, anti-androgens.

Question 13

What are complications of prostate cancer?

Answer 13

SCC: consider if retention, constipation, pain.

Ureteric obstruction. May need nephrostomy or stent.

Question 14

What are SE of radiotherapy?

Answer 14

• Dysuria
	• Frequency
	• Incontinence
	• Nocturia 
	• Diarrhoea
	• Rectal bleeding
Stricture