Prostate Cancer

Question 1

What is the presentation of prostate cancer?

Answer 1

Mostly asymptomatic
May present with locally invasive disease which causes symptoms i.e.;
- haematuria
- perineal and suprapubic pain
- impotence
- incontinence
- loin pain or anuria resulting form obstruction of the ureters
- symptoms of renal failure
- haemospermia
- rectal symptoms i.e. tenesmus

Question 2

How is the site of prostate cancer described?

Answer 2

Site is based on zones characterised by McNeils prostatic zones

Question 3

Where in the prostate does majority of prostate cancer arise?

Answer 3

Peripheral zone

Question 4

What are the risk factors for prostate cancer?

Answer 4

Age
Race/ethnicity (african / afrocarribean have higher risk than asian)

Geohgraphy (NW europe, north america, australia has a higher risk than asia and south /central america

Family history

Question 5

What is the risk of someone getting prostate cancer if their brother also had it?

Answer 5

2x risk with first degree relative

Question 6

What genes are associated with prostate cancer?

Answer 6

HPC1

BRCA 1 & 2

Question 7

How do you diagnose prostate cancer?

Answer 7

PSA testing
Digital rectal exam
TRUS - guided prostate biopsies

Question 8

What is the downfall of PSA testing?

Answer 8

It has high sensitivity but low specificity

Alot of false positives

Question 9

Apart from prostate cancer what can raise PSA?

Answer 9

Infection
Ejaculation 
UTI
Chronic prostatitis
Instrumentation
Recurrent urological procedure
BPH

Question 10

What is the name of the PSA testing?

Answer 10

Ad hoc PSA testing

Question 11

If PSA is elevated, would you immedietly do a biopsy?

Answer 11

You would re do the PSA test in 3 weeks (after 8 half lifes) unless it is markedly elevated
This is because PSA can be elevated because of other reasons

Question 12

What staging is used for prostate cancer?

Answer 12

TNM

Question 13

What is used to grade prostate cancer?

Answer 13

Gleason pathological grading system

Question 14

What is the purpose of grading vs staging?

Answer 14

Grading assesses how aggressive the cancer is - how well or poorly it is differentiated
TNM assesses the spread of the cancer

Question 15

What lymph nodes does prostate cancer spread to?

Answer 15

Internal illiac lymph nodes

Question 16

How would you investigate the stage of prostate cancer?

Answer 16

Digital rectal exam
PSA (> 50 likley to have spread)
Transurethral US guided biopsy
CT
MRI

Question 17

What are the treatment options for low risk localised prostate cancer?

Answer 17

Active surveillence
Surgery
EBRT
Brachytherapy

Question 18

What is the treatment for intermediate risk localised prostate cancer?

Answer 18

Surgery
EBRT +/- hormone therapy
Brachytherapy +/- hormone therapy

Question 19

What is the treatment for high risk localised prostate cancer?

Answer 19

EBRT + hormone therapy

Question 20

What is the prognosis of localised prostate cancer?

Answer 20

> 90% 15 year survival

Question 21

What is the prognosis for locally advanced prostate cancer?

Answer 21

80-90% 5 year survival

Question 22

What is the prognosis for metastatic prostate cancer?

Answer 22

Median survival 3-5 yrs