Prostate problems

Question 1

Risk factors

Answer 1

Old age, obesity, Afro-Caribbean heritage, family history.

Question 2

Symptoms

Answer 2

Urinary hesitancy, retention, haematuria, haematospermia, pain in the back, testicles or perineum.
Metastatic disease- bone pain.

Question 3

Investigations

Answer 3

PSA- tumour marker. Levels can also be raised due to BPH, UTI, prostatitis, ejaculation, exercise.
PR exam- asymmetrical hard nodular prostate, loss of median sulcus.
Transrectal USS + biopsy- being phased out.
Multiparametric MRI- gold standard. Out of 5 points: > 3 do biopsy, 1-2- consider.
CT and bone scan for staging.

Question 4

Grading system

Answer 4

Gleason grading system. 2 scores added together, never < 6. 6 is the best prognosis, 10 is the worst.

Question 5

Pathophysiology

Answer 5

95% adenocarcinoma, multifocal, 70% effect peripheral zone.

Question 6

Treatment

Answer 6

In the elderly with co-morbidities and a low Gleason score -> watch and wait.
Low risk men- active surveillance.
Otherwise: RT, surgery (radical prostatectomy, often leads to erectile dysfunction) and hormonal therapy (LHRH analogues and anti androgens to block testosterone).

Question 7

Hormonal therapy

Answer 7

Synthetic GnRH agonist e.g. Goserelin

Cover initially with an anti-androgen e.g. cyproterone