Session 11: Urological Cancers - Prostate Cancer

Question 1

Epidemiology of prostate cancer.

Answer 1

Most common cancer in men

2nd most common cause of death from cancer in men.

1 in 8 will be diagnosed in their lifetime

Incidence is increasing

Rare in men aged <50

Nearly every man in their 80s have prostate cancer

Question 2

Risk factors of prostate cancer

Answer 2

Increasing age

Family history (4x)

BRCA2 gene mutation

Black>white>asian

Question 3

Type of screening of prostate cancer.

Answer 3

Not mass population but opportunistic meaning that if you come in with associated symptoms you can be screened for.

If you come in to discuss about a family member who has prostate cancer or because they have read about the test.

Question 4

What kind of test is screening for prostate cancer?

Answer 4

PSA (prostate specific antigen) blood test

Question 5

Issues for PSA screening

Answer 5

Over-diagnosis

Over-treatment

Cost-effectiveness

Other causes of raised PSA

Having a normal PSA does not mean you do not have prostate cancer.

Question 6

Give other causes of raised PSA

Answer 6

Infection

Inflammation

Large prostate

Urinary retention

Question 7

Examination of prostate cancer

Answer 7

DRE

Question 8

Clinical presentation of prostate cancer

Answer 8

Urinary symptoms

Bone pain

Change in bowel habits

Question 9

How might prostate cancer be diagnosed.

Answer 9

Had PSA check and then biopsy

Incidental finding at transurethral resection of prostate (TURP)

DRE

Question 10

Factors influencing treatment of prostate cancer

Answer 10

Age

DRE (whether it is localised, locally advanced or advanced)

PSA levels are important (very high levels rules out treatment)

Biopsies like gleason grade

MRI scan and bone scan to assess grade by nodal and visceral metastases

Question 11

Treatment of localised prostate cancer

Answer 11

Surveillance

Robotic radical prostatectomy

Radiotherapy

Question 12

Treatment of locally advanced prostate cancer

Answer 12

Surveillance

Hormones

Hormones and radiotherapy

Question 13

How does bone metastases relate to PSA levels.

Answer 13

It is very unlikely to have metastasised if PSA levels are below 10ng/ml

Question 14

Function of bone metastases from prostate cancer.

Answer 14

They are sclerotic aka osteoblastic

Compared to most bone metastases which are the opposite

Question 15

Treatment of metastatic prostate cancer

Answer 15

Hormones +/- chemotherapy.

Surgical castration

Medical castration via LHRH agonists

Palliation - Radiotherapy and chemotherapy