Prostate Cancer

Question 1

What is prostate cancer

Answer 1

mostly adenocarcinomas that develop in the peripheral zones of the prostate gland. Commonest sites of metastasis are bone and lymph nodes.

Prostate cancer is the commonest cancer in men. 26% of cancer in men. 1 in 9 men in UK. Peak age is 65 and 75 year olds.

Question 2

Risk factors of prostate cancer

Answer 2

Increasing age - 25% younger than 65

Black African-carribean more than white

One first degree relative affected then risk doubles.

Many are androgen dependent

Question 3

Prostate cancer Clinical features

Answer 3

2/3 asymptomatic. 1/3 LUTS: Weak stream, hesitancy, frequency, urgency, incomplete emptying.

Haematuria, dysuria, incontinence

Impotence

Metastatic spread:
Back/ Bone pain
Weigh loss
Lymphadenopathy
Lethargy (anaemia, uraemia)

Question 4

Signs of Prostate cancer

Answer 4

Palpable bladder if outflow obstruction

PR – irregular hard prostate upon palpation, irregular

Question 5

Differential diagnosis of prostate cancer

Answer 5

Heamturia causes (UTI)

BPH

Prostatitis

Bladder tumours – haematuria no pain

Question 6

Investigation of prostate cancer

Answer 6

PSA – glycoprotein enzyme secreted by prostate gland

PCA3 expensive but better than above

Urinalysis (bladder renal cause)

MSU MC&S (infection)

Renal function test U&E + creatinine

Prostate biopsy – not for everyone tho

MRI/CT -> TNM staging

Question 7

How to manage prostate cancer

Answer 7

Non-metastatic disease
o Radical total prostatectomy or laparoscopic
o Radiotherapy very effective
o Cryotherapy or high intensity focused ultrasound
o Hormone therapy – may assist in slowing down tumour growth.

10% live for >10years and 10% die within 6months.

Most people die with the cancer not from it.