Prostate Carcinoma

Question 1

What is a prostate adenocarcinoma

Answer 1

cancer of the glandular epithelium in the prostate

Question 2

who gets prostatic adenocarcinoma

Answer 2

men that are androgen dependant

african ethnicity

obesity

smokers

old

FH

pesticide exposure

Question 3

how does a prostatic adenocarcinoma present

Answer 3

can be asymptomatic

same symptoms as BPH:

• hesitancy
• frequency
• dribbling
• nocturia

haematuria
systemic symptoms e.g. weight loss

Question 4

how do you investigate prostatic adenocarcinoma

Answer 4

1st line= urine dip for haematuria and PR exam

PSA (but has poor specificity and sensitivity)

MRI helps to grade it

isotope bone scan to check for local metastasis

Question 5

what is the grading system called for prostate cancer

Answer 5

Gleason Grading System

1-5 based on how differentiated the cells are

Question 6

how do you manage a prostatic adenocarcinoma

Answer 6

non-hormonal:

• active surveillance
• radiotherapy

hormonal:

• gnRH analogues to block LH and FSH e.g. goserelin
• androgen receptor blockers e.g. bicalutamide

surgical:
- removal

Question 7

why is PSA not a reliable indicator of prostate cancer

Answer 7

lots of things can cause it to be raised e.g.:

• BPH
• recent ejaculation
• PR exam
• urethral instrumentation
• UTI
• prostatitis
• vigorous exercise

Question 8

what are the DD’s for prostate cancer

Answer 8

BPH

Prostatitis

Question 9

what 2 drugs are often given in prostate cancer

Answer 9

gnRH analogues to block FSH and LH
e.g. Goserelin

androgen receptor blockers
e.g. bicalutamide