prostate cancer and PSA

Question 1

What does PSA stand for

Answer 1

prostate-specific antigen (PSA) test

Question 2

what type of cancer is prostate cancer

Answer 2

Adenocarcinoma

Question 3

which zone of the prostate does cancer occur

Answer 3

peripheral

Question 4

how does pristate cancer spread locally

Answer 4

through the prostate capsule

Question 5

where does prostate cancer commonly metastesize

Answer 5

• Metastasises to lymph nodes and bone (sclerotic) and occasionally to lung, liver and brain

Question 6

what are Biomarkers for prostate cancer

Answer 6

• Tissue
• Serum
  -Prostate-specific Antigen (PSA)
  -Prostate-specific membrane antigen (PSMA)
• Urine
  -PCA3
  -Gene fusion products (TMPRSS2-ERG)

Question 7

is elevated PSA indicative of cancer

Answer 7

no
elevated in benign, UTI’s, prostatitis 70% of men with an elevated PSA will not have prostate cancer

Question 8

what level of PSA would be 99% effective at determingin cancer

Answer 8

PSA of 100 + (ng/mL)

Question 9

how is prostate cancer diagnosed

Answer 9

• Lower urinary tract symptoms (LUTS)
• Prostate specific antigen (PSA)
• Transrectal ultrasound scan (TRUSS)
• Prostate biopsy
• Prostate cancer grading (Gleason grading)

Question 10

how is prostate cancer graded

Answer 10

gleason grading

Question 11

how is prostate cancer staged

Answer 11

• T stage T1 - no palpable tumour on DRE T2 - palpable tumour, confined to prostate T3 - palpable tumour extending beyond prostate
• N stage MRI scan, CT scan, (laparoscopy)
• M stage Bone scan

Question 12

how is localised prostate cancer treated

Answer 12

• Surgery - radical prostatectomy open, laparoscopic, robotic
• Radiotherapy - external beam - brachytherapy
• Observation - watchful waiting - active monitoring/ surveillance
• Focal Therapy e.g. High intensity ultrasound (HIFU), photodynamic therapy (TOOKAD)

Question 13

what are the arguments for and against radicak removal of the prostate

Answer 13

For
* curative
* ngitudinal studies showing benefit
* high mortality of the cancer

Against
* disease of the elderly
* competing cause of death
* adverse effects of treatment
* 30% die fo the cancer

Question 14

Give for and against arguments for screening for prostate cancer

Answer 14

For
* commonest cancer in men
* 10k deaths per year in uk

Against
* Uncertain natural history
* Overtreatment
* Morbidity of treatment

Question 15

Benefits and Risks of PSA testing

Answer 15

Benefits
* Early diagnosis of localised disease (cure)
* Early treatment of advanced disease (effective palliation)

Risks
* Overdiagnosis of insignificant disease
* Harm caused by investigation/ treatment

Question 16

what is the treatment of metaststic prostate cancer

Answer 16

surgical castration
-survival 2,5 yrs