Prostate Cancer ☺️

Question 1

Epidemiology

Answer 1

The most common male cancer
Common in older men
Black
FHx

Question 2

Presentation

• early
• locally advanced
• late

Answer 2

Early - none
Locally advanced disease - LUTS, urinary symptoms, pelvic pain
Late - hematuria/LUTS/bone pain/weight loss

Question 3

Investigations

• definitive
• staging

Answer 3

Urine dip => rule out UTI
Flow rate => assess impact on urination
PSA - high => determine cause with MRI
DRE - large, lumpy, hard

Definitive - transrectal USS + biopsy
Staging - MRI/PETCT bone scan
Graded on Gleason scale

Question 4

PSA screening

• what is PSA
• when would it be elevated?

Answer 4

PSA formed in prostate => secreted into prostatic ducts
Some leaks into blood => measured

Normal elevation 4+

• UTI
• prostate stimulation/recent ejaculation/anal sex
• vigourous exercise
• BPH

Abnormal elevation 4+
-prostate cancer

Question 5

Types and lymphatic spread

Answer 5

Most common adenocarcinoma
-majority in peripheral zone
LN => obturator
Spread to seminal vesicles associated with distant disease

Question 6

Management

• low risk
• disease progression

Answer 6

Low risk - watch and wait
-older adults, many comorbidities

Disease progression => offer radical treatment
Surgery - radical prostatectomy, obturator LN removal
-SE - erectile dysfunction

Radio - external/bradytherapy

Hormonal surgical - bilateral orchidectomy (T release stimulates prostate tissue growth)
Hormonal medical - LHRH analogue, antiandrogens

Question 7

2WW for prostate cancer

Answer 7

Prostate feels malignant on DRE

PSA in men with 
-LUTS
-erectile dysfunction
-VH
Refer if PSA above age specific range

Question 8

Side effects of prostate cancer management

Answer 8

Infertility
Inpotence
Incontinence