Prostate cancer

Question 1

Describe the epidemiology of prostate cancer. (2)

Answer 1

Very common in old men - all men over 80 have it. 2nd commonest cause of cancer death.

Question 2

Describe the risk factors for prostate cancer. (4)

Answer 2

Increased age
Family history - BRCA2 or 1st degree relative under 60 with it.
Black > white > Asian.

Question 3

Describe the screening that occurs in the UK for prostate cancer. (6)

Answer 3

Not recommended with no symptoms. If someone has urinary symptoms or FH then OFFER a PSA - don’t do on everyone because of:
Over-diagnosis - you have no symptoms
Over-treatment - bad side effects of treatment
Other causes - infection, inflammation, BPH, urinary retention.
Normal PSA does not equal no cancer.

Question 4

Describe the presentation of prostate cancer. (5)

Answer 4

Urinary symptoms, bone pain (always mets to bone but sclerotic - hypocalcaemia), DRE for change in bowel habit, incidental finding in TURP.

Question 5

Describe the diagnosis of prostate cancer. (2)

Answer 5

TRUS - transracial ultrasound guided biopsy.

Transperineal biopsy.

Question 6

Describe the factors that affect treatments of prostate cancer. (4)

Answer 6

Age, staging PSA levels (higher = more aggressive = more mets), grade (Gleason grading system), bone mets seen.

Question 7

Describe the treatments of prostate cancer. (8)

Answer 7

Localised: surveillance, robotic prostectomy, radiotherapy.
Locally advanced: surveillance, normal therapy, radiotherapy.
Metastatic: hormone with chemotherapy to reduce testosterone - castration - LH releasing hormone agonists.
Palliative: radiotherapy, bisphosphates, chemotherapy.

Question 8

Describe the differences in positioning between BPH and CaP.

Answer 8

CaP usually occurs in the peripheral zone - palpable on DRE.
BPH usually occurs in the transition zone.