Urological Cancers - Prostate Cancer

Question 1

Prostate cancer - epidemiology, presentation

Answer 1

Commonest cancer in men (1/8), 2nd commonest cancer death cause men, rare <50yrs, nearly every man 80s

Risk factors: older, FH, BRCA2 mutation, black then white then Asian

Presentation:
Urinary symptoms, bone pain, pSA biopsied, direct rectal examination, incidental transurethral resection of prostate

Question 2

Screening for prostate cancer how it is done, issues

Answer 2

Opportunistic screening if patients counselled - prostate specific antigen blood test (associated symptoms/ FH/ they ask about it)

Issues: over diagnosis, over treatment, QoL, costs, other causes raised PsA (infection - within 6 weeks UTI, inflammation, large prostate), having normal doesn’t mean you don’t have prostate cancer,

Question 3

Diagnostic pathway for prostate cancer

Answer 3

Direct racial screening or serum PSA -> transurethral ultrasound guided biopsy of prostate

Lower urinary tract symptoms -> Transurethral resection of prostate

Question 4

Principles of treatment prostate cancer

Answer 4

Depends: age, DRE, PSA level, biopsies, MRI scan and bone scan

✅localised:
Surveillance, robotic radical prostatectomy, radiotherapy (external beam/ brachytherapy)

Locally advanced:
Surveillance, hormones, radiotherapy

Metastatic:
Hormones +/- chemotherapy (surgical castration, medical castrations, LHRH agonists), palliative (single dose radiotherapy, bisphosphonates, chemotherapy, new treatments)