Prostate Cancer

Question 1

What is the Epidemiology of Prostate Cancer, what are the common risk factors?

Answer 1

• COMMON
• 2nd most common cause of male cancer deaths

Risk Factors

1. Age (BIGGEST ONE)
2. Afro-Caribbean
3. Family history (e.g. BRCA 2 gene, breast cancer + prostate cancer are associated, Chr 1 implicated)
4. Dietary factors (high fat, meat/ alcohol consumption high)
5. Occupational exposure to cadmium

Question 2

What are the Clinical features of Prostate Cancer, how does it differ in a metastatic spread?

Answer 2

Often ASYMPTOMATIC

Lower Urinary Tract Obstruction

1. Hesitancy
2. Poor stream
3. Terminal dribbling
4. Nocturia
5. pain when urinating

Metastatic Spread

1. Bone pain
2. Cord compression
3. Systemic symptoms: malaise, anorexia, weight loss
4. Paraneoplastic syndromes (e.g. hypercalcaemia)

Question 3

What are the methods for diagnosis Prostate Cacner?

Answer 3

PSA

• NOTE: not a very specific test for prostate cancer – can also be raised if benign or with prostatitis/ UTIs [older patients are more likely to pick up UTIs]/ cycling/ trauma e.g. catherisation or surgery. PSA level increases with age so might have different normal for different ages

CT/MRI Scan

• Assesses extent of local invasion and lymph node involvement

Transrectal Ultrasound and Needle Biopsy

• Gleason score:
• Low risk: 3+3
• High risk: 5+5

Question 4

What are the possible treatments of Prostate Cancer?

Answer 4

Watchful waiting

• Older people
• Low grade tumours

Radical protatectomy

• Confined to prostate gland
• SE: incontinence & impotence
• PSA levels <10-12ng/ml and age <70 years, giving the group with the highest chance for survival

External beam radiotherapy/ radioactive “seeds”

• tumour has spread outside of the prostate capsule but has not affected other organs
• SE: incontinence & impotence

Met needs hormone therapy (maybe in combo with one of the prevoptions) + chemical bilateral orchidectomy to remove main source of testosterone (LHRH agonist)

HOW IT WORKS? Over-stimulates the pituitary receptor, causing them to become desensitized such that they no longer response to LHRH so LH and testosterone production stopped

Weak androgens produced by adrenal glands 🡪 anti-androgens are used

bind to the androgen receptor to prevent its activation by androgens, and may also actively repress androgen target genes

SE: osteoporosis, loss of libido, anaemia, muscle atrophy, memory loss and gynaecomastia