Prostate Carcinoma

Question 1

How common is it?

Answer 1

The commonest male malignancy.

Question 2

Who does it affect?

Answer 2

Older men – 80% in men >80yrs.

Question 3

Risk factors?

Answer 3

• +ve family history, ↑testosterone.

Question 4

How does it present?

Answer 4

Symptoms

• Asymptomatic
• Nocturia, hesitancy, poor stream, terminal dribbling or obstruction.
• ↓Weight ± bone pain suggests mets.

On DRE exam of prostate
- Hard, irregular prostate.

Metastasis

• May be local (seminal vesicles, bladder, rectum)
• Via lymph
• Haematogenous (sclerotic bone lesions

Question 5

Investigations?

Answer 5

• PSA↑ (normal in 30% of small cancers)
• Transrectal USS & biopsy
• X-rays/Bone scan/CT/MRI
• Staging – MRI – If contrast-enhancing magnetic nanoparticles used, sensitivity for detecting affected nodes rises from 35% to 90%.

Question 6

Treatments?

Answer 6

For disease confined to prostate…

• Depends on prognosis, co-morbidities and patient preference.
• Radical prostatectomy – if 70yrs and low-risk.

Metastatic Disease…

• Hormonal drugs – may give benefit for 1-2 years.
• For symptomatic disease – analgesia, treat hypercalcaemia, radiotherapy for bone mets/spinal cord compression.
• Prognosis – 10% die in 6 months, 10% live >10 yrs.