Urology - Prostate Cancer

Question 1

Epidemiology

Answer 1

• Commonest male Ca
• 3rd commonest cause of male Ca death
• 80% of men over 80 have some form of it

Question 2

Pathology

Answer 2

-Adenocarcinoma in the peripheral zone of prostate

Question 3

Patient presentation

Answer 3

• usually asymptomatic
• Urinary: nocturia, frequency, hesitancy, poor stream, terminal dribbling and obstruction
• Systemic: wt loss, fatigue
• Mets: bone pain

Question 4

Pr examination - notable findings

Answer 4

• Hard/irregular prostate on PR

- Loss of midline sulcus

Question 5

Potential routes of spread

Answer 5

• Local: seminal vesicles, bladder, rectum
• Lymph para-aortic nodes
• Haem: sclerotic bone lesions

Question 6

Ix

Answer 6

• Bloods: PSA, FBC, U+E, uric acid, alp phos, Ca markers
• Imaging: XR chest and spine, transrectal US + biopsy, bone scan, staging MRI (contrast enhances detection of affected nodes)

Question 7

What is the name of the scale used to grade prostate cancer?

Answer 7

-Gleason score

Question 8

Outline the TNM classification for prostate cancer

Answer 8

• T is: carcinoma in situ
• T1: incidental finding on TURP or raised PSA
• T2: intracapsular tumour with deformation of prostate
• T3: extra-prostatic extension
• T4: fixed to pelvis + invading neighbouring structures
• N1-4: 1 or more lymph nodes involved
• M1: distant mets (eg spine)

Question 9

Mx- general principles

Answer 9

• Difficult to know which tumours are indolent and which will never cause problems
• Radical therapy is associated with significant morbidity :(

Question 10

Mx: conservative

Answer 10

-Active monitoring with PSA and DRE

Question 11

Localised prostate cancer (T1/T2) rx

Answer 11

Rx depends on life expectancy and pt choice. Options:

• Conservative: DRE/PSA active monitoring and watchful waiting
• radical prostatectomy
• radiotherapy: external beam and brachytherapy

Question 12

Localised advanced prostate cancer (T3/T4)

Answer 12

Options include:

• Hormonal therapy (next slide)
• radical prostatectomy
• radiotherapy: external beam and brachytherapy

Question 13

Metastatic prostate cancer disease- hormonal therapy

Answer 13

Synthetic GnRH agonist

• Eg Goserelin (Zoladex)
• Cover initially with anti-androgen to prevent rise in testosterone

Anti androgen
-Cyproterone acetate prevents DHT from binding to intracytoplasmic protein complexes

Question 14

Mx: symptom relief

Answer 14

• TURP for obstruction
• Analgesia
• Radiotherapy for bone mets/chord compression