Prostate Carcinoma

Question 1

EPIDEMIOLOGY: Prostate Carcinoma

Answer 1

• Most common cancer in males in WW
• 40% cases = early disease
• 20% = metastatic disease

Question 2

RISK FACTORS: Prostate Cancer

Answer 2

• Age
• FHx Prostate Cancer
  
  • 1st degree relative = x2 risk

Question 3

CLINICAL FEATURES: Prostate Cancer

Answer 3

Symptoms

• LUTS (storage and voiding symptoms)
• Haematuria/spermia

Signs

• Hard nodular prostate on DRE
• Incidental diagnosis after TURP
• Advance disease =
  
  • acute renal failure from ureteric obstruction
  • Bone pain
  • Pathological fracture
  • Spinal cord compression
  • Malaise
  • Weight loss

Question 4

INVESTIGATIONS: Prostate Cancer

Answer 4

• Bloods*
• Serum PSA - disease monitor (high sensitivity but low specificity)
• Imaging*
• Transrectal ultrasound (TRUS) systematic needle biopsy with Gleason grading
• Pelvic MRI - presence of lymphadenopathy/extracapsular extension
• Laparoscopic node biopsy - performed to sample enlarged nodes
• Isotopic bone scan - mets

Question 5

MANAGEMENT: Prostate Cancer

Answer 5

Localised disease

• Active survelliance: monitor PSA and treat if PSA rises or cancer upgraded on repat biopsy
• Radiotherapy: external beam or brachytherapy (125iodine seed implantation)
• Surgery: laparoscopic, robotic or open radical prostatectomy

Advanced disease

• Medical: hormonal manipulation
  
  • GnRH agonist (eg GOSELIN, LEUPRORELIN, TRIPTORELIN),
  • GnRH antagonists (eg DEGARELIX),
  • Testoterone antagonists (eg FLUTAMIDE)
• Surgery: Castration
• Radiotherapy: treat painful bone metastases

Question 6

PATHOLOGY: Prostate Carcinoma

Answer 6

• 95% adenocarcinoma
• Often multifocal- 70% in peripheral zone.
• Graded using the Gleason grading system,
  
  • 2 is best prognosis and 10 the worst.
• Mets = adrenal gland, bone, liver, lung