Prostate Carcinoma

Question 1

How common is prostate carcinoma?

Answer 1

7% of all cancers affecting men.
2nd most common cancer in men
6th most common in the world

Question 2

Who does prostate cancer affect

Answer 2

80% of 80year olds

Question 3

What are the symptoms of prostate carcinoma?

urinaryl, local invasion and metastatic

Answer 3

Urinary symptoms:
Weak stream,
hesitancy,
sensation of incomplete emptying, 
urinary frequency,
urgency, 
incontinence
Haematuria
nocturia

Local invasion:

• dysuria
• obstruction of ureters causes loin pain, symptoms of AKI, anuria
• impotence
• tenesmus (feeling of urgency to evacuate bowel, but little stool)
• perineal / suprapubic pain

Metastatic disease:

• Bone pain
• sciatica.
• Paraplegia secondary to spinal cord compression.
• Lymph node enlargement.
• Lethargy (anaemia, uraemia).
• Weight loss, cachexia.

Question 4

What does the prostate (Prostate carcinoma) feel like on rectal examination?

Answer 4

Prostate feels:
- Hard 
- irregular surface (nodules)
- asymmetrical lobes
- lack of mobility
-

Question 5

What invx are done for prostate carcinoma?

Answer 5

• PSA ( PSA >4 is abnormal this is a sign of BPH OR Prostate Ca - only 30% of raised PSA have Prostate Ca.)
• Transrectal USS and biopsy of prostate
• Bone scan (for mets)
• CT
• MRI (helps with staging to identify affected lymph nodes)

-urine analysis (signs of infection)

- Bloods:
FBC (anaemia)
U+Es (AKI  due to obstruction)
CRP
LFTs (liver mets)

Question 6

What is the management of prostate carcinoma that is confined to the prostate?

Answer 6

Depends on prognosis (gleason histology score and TNM staging) :
If good then - watch and wait. (especially if 70yrs+ and low risk)

If not good prognosis then:

• Radical prostatectomy ( if less than 70yrs, this gives good diseae free survival prospects)
• Radical radiotherapy
• Hormone therapy delays tumour progression

Question 7

What system is used to histologically grade prostate carcinomas?

Answer 7

Gleason system:

score of 2 is the most well differentiated tumour.
Score of 10 is the most poorly differentiated and has the worst prognosis.

Question 8

What is the most common type of prostate carcinoma and where do they arise?

Answer 8

Adenocarcinoma is the most common type of prostate carcinoma and it arises in the peripheral parts of the prostate.

Question 9

Who should be considered for watch and wait (prostate carcinoma) management/

Answer 9

patients who are 70yrs+ with low risk and good prognosis.

Question 10

What is the treatment for metastatic prostate carcinoma?

Answer 10

• hormonal drugs e.g. LHRH agonist

-Symptomatic treatment: analgesia,
treat hypercalcaemia,
- radiotherapy for bone mets / spinal cord compression

Question 11

What is the prognosis for metastatic prostate cancer?

Answer 11

10% die within 6 months.
but
10% live for more than 10 years.