Prostate cancer

Question 1

True or false: prostate cancer is the most common cancer in men

Answer 1

True

Question 2

Advanced prostate cancer most commonly spreads to the ______ ____ and ____

Answer 2

lymph nodes and bones (thick sclerotic lesions)
Also to liver, lung and brain

Question 3

Prostate cancer is almost always a_____-dependent as they rely on a_____ hormones to grow

Answer 3

androgen

Question 4

The majority of prostate cancers are __________ (type of cancer) and grow in the peripheral zone of the prostate

Answer 4

adenocarcinomas

Question 5

What are risk factors for prostate cancer

Answer 5

Age
Family history
Black African or Caribbean origin
Tall stature
Anabolic steroids

Question 6

What genes are associated with prostate cancer?

Answer 6

BRCA2 and HOXB13

Question 7

Prostate cancer may be asymptomatic or may present with lower _____ ___ symptoms like benign prostate hyperplasia

Answer 7

urinary tract

Question 8

What are some lower urinary tract symptoms?

Answer 8

Hesitancy
Frequency
Weak flow
Terminal dribbling
Nocturia

Question 9

What are some other non-lower urinary tract symptoms of prostate cancer?

Answer 9

Haematuria
Erectile dysfunction

Symptoms of advanced disease / metastasis:
weight loss
Bone pain
Cauda equina syndrome

Question 10

Epithelial cells of the prostate release p____-s____ a_____ which is a glycoprotein.

Answer 10

prostate-specific antigen (PSA)

Question 11

PSA is secreted in the _____ with small amount entering the blood

Answer 11

semen

Question 12

True of false: PSA’s enzymatic activity helps to thicken the semen after ejaculation

Answer 12

False
It helps to thin the thick semen into a liquid consistency after ejaculation

Question 13

True or false: a raised level of PSA can indicate potential prostate cancer

Answer 13

True

Question 14

Is PSA testing reliable for screening?

Answer 14

Has a high rate of false positives (75%) and false negatives (15%)

Question 15

What else can cause raised PSA levels?

Answer 15

Benign prostatic hyperplasia
Prostatitis
UTIs
Vigorous exercise, especially cycling
Reject ejaculation or prostate stimulation

Question 16

A prostate exam is performed during a d___ r___ examination

Answer 16

digital rectal

Question 17

How does a benign prostate feel?

Answer 17

Smooth, symmetrical and slightly soft with a maintained central sulcus (dip between the 2 lobes).

In hyperplasia, may be generalised enlargement.

Question 18

How may an infected of inflamed prostate feel?

Answer 18

May be enlarged, tender and warm

Question 19

How may a cancerous prostate feel?

Answer 19

Firm or hard and asymmetrical, craggy or irregular.
Loss of central sulcus
Possible hard nodule

Question 20

What are the next steps after finding a potential prostate cancer from an examination?

Answer 20

2 week wait referral to urology

Question 21

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

Answer 21

Multiparametric MRI

Question 22

What is the Likert scale?

Answer 22

Scale 1-5 to rate how likely it is a cancer
1 = very low suspicion
5 = definite cancer

Question 23

After taking a multiparametric MRI, what is the next stage in investigation?

Answer 23

Prostate biopsy (however risk of false-negative if biopsy misses cancerous area)

Question 24

What are the 2 options for prostate biopsy?

Answer 24

Transrectal ultrasound-guided biopsy (TURS, through rectum into prostate)
or
Transperineal biopsy (through skin behind testicles)

Question 25

What are the main risks of a prostate biopsy?

Answer 25

Pain Bleeding (stools, urine or semen) Infection Urinary retention (due to short term swelling of prostate) Erectile dysfunction

Question 26

What imaging can be used to look for bony metastasis?

Answer 26

An isotope bone scan (also called radionuclide scan)

Question 27

How does an isotope bone scan work?

Answer 27

IV injection of radioactive isotope Wait 2-3 hours Bone takes up isotope metastatic bone lesions take up more of isotope Gamma camera takes picture of skeleton Lesions stand out more on scan

Question 28

What grading system is used from the prostate biopsies and is used to determine treatment?

Answer 28

Gleason grading system (2 number added together for total score)

Question 29

What do the 2 numbers of the Gleason score indicate?

Answer 29

First number is the grade of the most prevalent pattern in the biopsy Second number is grade of second most prevalent pattern in biopsy Score of: 6 = low risk 7 = intermediate risk 8+ = high risk

Question 30

What treatment is available for prostate cancer?

Answer 30

Surveillance in early stage External beam radiotherapy Brachytherapy Hormone therapy Surgery

Question 31

What is a complication of external beam radiotherapy?

Answer 31

Proctitis, inflammation in the rectum causing pain, altered bowel habit or rectal bleeding and discharge

Question 32

What is brachytherapy?

Answer 32

Implanting radioactive metal "seeds" into the prostate to deliver continuous targeted radiotherapy

Question 33

True or false: prostate cancer is the most hormone sensitive cancer

Answer 33

True