Prostate cancer

Question 1

Epidemiology - genetics, ethinicity, diet

Answer 1

• HOXB13, BRCA 1+ 2
• African-American & black caribbean
• Saturated fat + lots of dairy

Question 2

Incidence

Answer 2

Commonest cancer in men
Over 70
FH history - x3.5 risk
Highest rate in Scandinavia.

Question 3

Where does majority of adenocarcinomas arise from

Answer 3

75% peripheral zone
20% transitional zone
5% central zone

Question 4

Modifiable risk factors

Answer 4

Obesity
Diabetes mellitus
Smoking
Degree of exercise

Question 5

Investigation (exam)

Answer 5

DRE - check for asymmetry, nodularity, fixed irrgualr mass

Question 6

Lab test done?

Answer 6

PSA - can be elevated in prostate cancer.

Question 7

imaging done (3)

Answer 7

multi-parametric MRI scan (identifies abnormal tissues to be targeted for biopsy).
CT chest-abdomen pelvis (staging)
PET-CT nuclear medicine scan (staging)

Question 8

For dianosing cancer what do you do.

Answer 8

Obtain biopsy of the tissue via:

1. Transperineal biopsy
2. Transrectal ultrasound-guided biopsy (TRUS)

Question 9

Classification used

Answer 9

Gleason grading system
6 being lowest score
10 being highest.

Question 10

What to give in localised prostate cancer.

Answer 10

Localised:
Active surveillence
Watchful waiting >70yrs
Radical prostatctomy
brachytherpay
cryotherapy

Question 11

What to do in locally advanced prostate cancer

Answer 11

1. Radiotherpy w hormones
2. Control symptoms/obstruction -> TURO
3. Watchful waiting -> if old, asymptomatic

Question 12

what to give in metastatic prostate cancer

Answer 12

1. Anti androgen therapy - Bicalutamide, slows progression, not curative
2. Chemotherapy.