Prostate Cancer

Question 1

Where does prostate cancer most commonly spread to?

Answer 1

Lymph nodes
Bones

Mainly androgen-dependent to grow

Question 2

Where do prostate cancers usually grow?

Answer 2

Majority are adenocarcinomas growing in the peripheral zone

Question 3

What are the risk factors of prostate cancer?

Answer 3

Age
Family history
Black African or Caribbean origin
Tall
Anabolic steroids

Question 4

How does prostate cancer present?

Answer 4

May be asymptomatic of with LUTS

• Hesitancy
• Frequency
• Weak flow
• Terminal dribbling
• Nocturia

May also have:
- Haematuria
- ED
- Cancer red flags

Question 5

What is PSA?

Answer 5

Prostate-Specific Antigen

Epithelial cells of prostate produce this enzyme into semen and small amount into blood to thin the semen into liquid

Specific to the prostate only

Question 6

What are the common causes of raised PSA?

Answer 6

Prostate cancer
BPH
Prostatitis
UTI
Vigorous exercise (especially cycling)
Recent ejaculation

Question 7

What does a benign, inflamed/infected and cancerous prostate feel like?

Answer 7

Benign
- Smooth
- Symmetrical
- Soft
- Maintained central sulcus

Inflamed
- Enlarged
- Tender
- Warm

Cancerous
- Hard
- Asymmetrical
- Craggy or irregular
- Loss of central sulcus
- Hard nodules

Question 8

What is the first-line investigation for suspected localised prostate cancer?

Answer 8

Multiparametric MRI

Question 9

How are results from Multiparametric MRI reported?

Answer 9

Using Likert scale

1- Very low suspicion
2- Low suspicion
3- Equivocal
4- Probable cancer
5- Definite cancer

Question 10

What is the next step in diagnosis after multiparametric MRI?

Answer 10

Prostate biopsy

Risk of false-negative if biopsy misses cancerous area, multiple samples needed, MRI to guide best target

Question 11

How is prostate biopsy carried out?

Answer 11

Transrectal ultrasound-guided biopsy

Transperineal biopsy
- Needle inserted through perineum under local anaesthetic

Question 12

What are the risks of prostate biopsy?

Answer 12

Pain
Bleeding
Infection
Urinary retention (due to short-term swelling of prostate)
ED

Question 13

What is an isotope bone scan used for?

Answer 13

Look for bony metastasis

Radioactive isotope given by IV, 2-3 hour wait

Gamma camera takes pictures of skeleton

Question 14

What is the Gleason Grading System?

Answer 14

Based on histology from biopsies

Specific to prostate cancer

Greater the score the more poorly differentiated the tumour
1-normal
5-abnormal

Made of two numbers
First number grade of most prevalent pattern
Second number, second most prevalent pattern

6-Low risk
7-Intermeiate risk
8-High risk

Question 15

How is prostate cancer managed?

Answer 15

MDT guided

• Surveillance
• External beam radiotherapy
• Brachytherapy
• Hormone therapy
• Surgery

Question 16

What is a key complication of external beam radiotherapy?

Answer 16

Proctitis

Inflammation in the rectum due to radiation

• Pain
• Altered bowel habit
• Rectal bleeding
• Discharge

Prednisolone suppositories help reduce inflammation

Question 17

What is brachytherapy?

Answer 17

Implanting radioactive metal seeds into prostate

Delivers continuous, targeted radiotherapy to prostate

Can cause:
- Cystitis
- Proctitis
- ED
- Incontinence
- Increased bladder and rectal cancer risk

Question 18

What does hormone therapy in prostate cancer involve?

Answer 18

Aim to reduce androgen level in combination with radiotherapy or alone in advanced disease when you cannot cure

• Androgen-receptor blockers (bicalutamide)
• GnRH agonists (goserelin or leuprorelin)
• Bilateral orchidectomy

Can cause:
- Hot flushes
- Sexual dysfunction
- Gynaecomastia
- Fatigue
- Osteoporosis

Question 19

How can prostate cancer be treated if it is confined to the prostate?

Answer 19

Radical prostatectomy

Can cause:
- ED
- Urinary incontinence