10.1 Prostate Cancer

Question 1

clinical manifestations of prostate cancer

Answer 1

Initial: pain from metastasis to bone
Sign of BPH, hematuria, painful ejeculation, blood in semen

Severe: rectal obstruction, bone pain, anemia, wt loss, weakness, pathological bone fracture, mental confusion

Question 2

diagnosis of prostate cancer

Answer 2

-DRE digital rectal examination
Early stage: non-raised, firm lesion with sharp edge
Advanced stage: hard and stone-like with irregular border
Further evaluate lymph node in groin

-PSA Prostate-Specific antigen
Tumor maker

• TRUS Transrectal USG
• transrectal ultrasound guided needle prostate biopsy = golden standard

Question 3

Surgical management for prostate cancer

Answer 3

-Radial prostatectomy (Early stage 1-2)
Remove entire prostate gland

• TURP transurethral resection of prostate (advanced stage)
  Symptoms (bladder outlet obstruction) relief only

Question 4

Side effect of prostate cancer surgery

Answer 4

Radial prostatectomy
- impotence, incontinence

TURP transurethral resection of prostate
- retrograde ejaculation

Question 5

Discharge advise after prostate surgery

Answer 5

• Expect pass blood in urine for first 2 weeks
  (Healing period last 4-8 weeks)
• Prevent URTI: avoid tub baths
• Prevent wound infection
• Decrease urge incontinence due to poor sphincter control: perform perineal Kegel exercise during voiding
• Avoid bleeding after surgery: no sexual intercourse for 6 weeks, avoid NSAID , aspirin for 2 weeks
• allow rest and heal
  avoid strenuous activity and heavy lifting,
• keep urine clean + avoid constipation
  Resume normal diet, increase fluid and fiber intake
• detect risk of recurrence: prostatic clinic follow-up/ 4-6month for 3 year

Question 6

Risk factor of prostatic cancer

Answer 6

Older age
Black people
Family Hx
Obesity

Question 7

Radiation therapy for prostate cancer

Answer 7

• EBT External beam therapy
• Brachytherapy (placement of radioactive seed)

Question 8

Side effect of brachytherapy

Answer 8

Inflammation of rectun, bowel and bladder

Question 9

Hormonal therapy for advanced prostate cancer

Answer 9

Suppressed androgenic stimuli:
Decrease level of circulating plasma testosterone

Question 10

PSA
DRC
Golden standard of prostate cancer diagnosis
Surgery name for prostate cancer

Answer 10

Prostate-specific antigen
Digital rectal examination
Transrectal ultrasound guided needle prostate biopsy
Radial Prostatectomy