Prostate cancer

Question 1

What is prostate cancer?

Answer 1

Malignant tumour of the prostate
95% Adenocarcinomas

Question 2

Describe the nature of prostate cancer growth

Answer 2

Mostly indolent + slow growing
Minority are aggressive + invade local structure/ metastasise

Question 3

Describe prevalence of prostate cancer in the UK

Answer 3

Most common cancer in men
2nd most common cause of cancer death in men

Question 4

List 4 risk factors for prostate cancer?

Answer 4

Age >50
Black/ Afro-caribbean ethnicity
FH
Obesity

Question 5

Describe onset of prostate cancer

Answer 5

Often ASYMPTOMATIC (esp. localised as tend to develop in periphery of prostate + don’t cause obstructive Sx early on)

Question 6

List 7 symptoms of prostate cancer caused by bladder outlet obstruction

Answer 6

Frequency
Urgency
Hesitancy
Poor stream
Terminal dribbling
Nocturia
Dysuria

Question 7

List 3 general symptoms of prostate cancer

Answer 7

Haematuria/ Haematospermia
Lethargy
Pain: back, perineal, testicular

Question 8

List 3 symptoms of advanced prostate cancer

Answer 8

Lower back pain
Bone pain
Weight loss

Question 9

Describe possible DRE findings in prostate cancer

Answer 9

Asymmetrical hard nodular enlargement with loss of median sulcus

May feel normal, does NOT r/o tumour

Question 10

What is the normal upper limit for PSA?

Answer 10

4 nanograms/ml
(though varies with age + race)

Question 11

List 4 causes of false positive PSA result

Answer 11

Prostatitis
UTI
BPH
Vigorous DRE

Question 12

What should people NOT have before PSA testing?

Answer 12

An active UTI or within previous 6w.
Ejaculated in previous 48h.
Exercised vigorously, e.g. cycling, in previous 48h.
Had a urological intervention e.g. prostate biopsy in previous 6w.

Question 13

When should PSA testing be utilised?

Answer 13

Consider in those with suspected prostate cancer
Offered to >50s who request PSA

NOT to asymptomatic people

Question 14

When should 2ww referal be made in suspected prostate cancer?

Answer 14

If prostate feels malignant on DRE
If Sx + raised PSA

Question 15

What is the firstline investigation for prostate cancer? How are results reported?

Answer 15

Multiparametric MRI
Results reported on 5-point Likert scale

Question 16

How are results of multiparametric MRI for prostate cancer acted upon?

Answer 16

> 3: multiparametric MRI-influenced prostate biopsy

1-2: pros + cons of biopsy discussed

Question 17

What investigation used to be first line for suspected prostate cancer?

Answer 17

Transrectal Ultrasound guided (TRUS) Biopsy

Question 18

List 4 complications of TRUS

Answer 18

Sepsis (1%)
Pain >2w
Fever
Haematuria + rectal bleeding

Question 19

What system is used for grading prostate cancer?

Answer 19

Gleason grading system

Question 20

Where does prostate cancer spread to first?

Answer 20

Lymphatic spread to obturator nodes
Local extra prostatic spread to seminal vesicles

Question 21

In which patients may a watch and wait approach be taken?

Answer 21

Elderly
Multiple co-morbidities
Low Gleason score

Question 22

Describe the management options for localised prostate cancer (T1/T2)

Answer 22

Conservative: active monitoring + watchful waiting
Radical prostatectomy
Radiotherapy

Question 23

Describe the management options for localised advanced prostate cancer (T3/T4)

Answer 23

Hormonal therapy
Radical prostatectomy
Radiotherapy

Question 24

Describe management options for metastatic prostate cancer

Answer 24

Hormone therapy
Radiotherapy
Chemotherapy

Question 25

How can radiotherapy be delivered in prostate cancer?

Answer 25

External beam Brachytherapy

Question 26

Name a common complication of radical prostatectomy

Answer 26

Erectile dysfunction

Question 27

Give 2 complications of radiotherapy for prostate cancer

Answer 27

Prostatitis Increased risk bladder, colon + rectal carcinoma

Question 28

What is one of the key aims of treating advanced prostate cancer? What strategies can be used for this?

Answer 28

Reduce androgen levels Anti-androgen therapy Chemotherapy (Docetaxel)

Question 29

Name a surgical method to rapidly reduce testosterone levels

Answer 29

Bilateral orchidectomy

Question 30

Name 4 drugs that can be used to reduce androgen levels in prostate cancer

Answer 30

Synthetic GnRH agonists/ antagonists Bicalutamide Cyproterone acetate Abiraterone

Question 31

Name a GnRH agonist and describe its use in prostate cancer

Answer 31

Goserelin (Zoladex) Paradoxically result in lower LH levels long term by causing overstimulation

Question 32

What unwanted affect occurs when using GnRH agonists in prostate cancer? How can this be mitigated?

Answer 32

Testosterone initially rises for 2-3w before falling to castration levels Use anti-androgen to prevent rise in testosterone 'tumour flare'

Question 33

Name a GnRH antagonist and describe its use in prostate cancer

Answer 33

Degarelix Suppress testosterone + avoid flare phenomenon

Question 34

What is Bicalutamide? How is this helpful in prostate cancer?

Answer 34

Non-steroidal anti-androgen Blocks the androgen receptor

Question 35

What is Cyproterone acetate?

Answer 35

Steroidal anti-androgen

Question 36

What is Abiraterone? When is this used?

Answer 36

Androgen synthesis inhibitor Tx of hormone-relapsed metastatic prostate cancer in those with no/ mild Sx after androgen deprivation failed + before chemo indicated