Prostate 2 (607-619)

Question 1

From which part of the prostate do cancers most commonly arisie?; ADD PIC OF PROSTATE ZONES

Answer 1

Peripheral zone. Posterior lobe.

Question 2

What types of cancers occur in the prostate?;

Answer 2

Adenocarcinoma (>95%), transitional cell carcinoma, neuro-endocrine.

Question 3

Name some risk factos for the development of prostate cancer;

Answer 3

Age, Ethnicity (lack african or Caribbean), family history. Modifiable risk factors- obesity, diabetes, smoking, low amount of exercise.

Question 4

What genes are associated with prostate cancer?;

Answer 4

BRAC 1 and BRAC 2 gene. HOX B gene.

Question 5

What investigations would you consider performing in a patient with suspected prostate cancer?;

Answer 5

Digital rectal exam, Prostate Specific Antigen (PSA), MRI scan of prostate +/- biopsy (US or MRI guided)

Question 6

What is the normal PSA level in an adult?;

Answer 6

ADD TABLE https://teachmesurgery.com/urology/prostate/prostate-cancer/

Question 7

What is the Gleason Grading System for prostate cancer?

Answer 7

Scoring system to grade prostate cancers, based upon histological appearance. Two scores e.g 4+3

Question 8

How is a Gleason score claculated?;

Answer 8

The sample of prostate tissue is assigned a score according to its differentioation and the Gleason score is then calculation as the sum of the most common growth pattern + second most common. The higher the Gleason score the poorer the prognosis (more agressive cancer).

Question 9

Name some optioms to treat prostate cancer;

Answer 9

Discussed at prostate cancer MDT. Treatment is based on risk startification level made from PSA level, Gleason score and staging. Treatment options either watchful waiting (symptom guided approach- intent not curative), active surveillance (curative treatment is considered when disease progresses) or curative management. Curative mx includes surgery- radial prostatectomy is mainstay of tx- includes removal of prostate gland, resection of seminal vesicle & surrounding tissue +/- lymph nodes. Alternative treatment for curative therapy include external beam radiotherapy, brachytherapy. Anti-androgen therapy and chemotherapy is the mainstay of treatment for metastatic prostate cancer.

Question 10

What management is provided in the first year of active surveillance for prostrate cancer?

Answer 10

PSA every 3 months. DRE after 1 year. MRI after 1 year.

Question 11

During active surveillance, what is the management after the second year and beyond?;

Answer 11

If 1st year normal. PSA every 6 months and DRE yearly (No MRI required). If patient too frail then watchful waiting only (symptom guided management).

Question 12

What is bracytherapy and what is its indications in prostate cancers?;

Answer 12

Transperineal implantation of radiactive seeds directly into the prostate gland, whilst external beam radiotherapy uses focused radiotherapy to target the prostate gland and limit damage to surrounding tissues.

Question 13

Name some hormonal approaches to treat prostate cancer;

Answer 13

Androgen deprivation therapy (Finasteride), LHRH agonist, GnRH antagonist. Surgical castration.