Prostate cancer

Question 1

what type of cancer are the majority of cancers found in the prostate

Answer 1

adenocarcinoma

Question 2

which zone do most prostate cancers arise from

Answer 2

peripheral zone

Question 3

how does the gleason score work

Answer 3

a pathologist determines the gleason score by analysing the histology from 2 separate areas of the tumour specimen

scores of 8-10 suggest an aggressive tumour

Question 4

what are the clinical features of prostate cancer

Answer 4

majority asymptomatic

bladder outflow obstruction

acute urinary retention

Question 5

what investigations should you do if you suspect prostate cancer

Answer 5

FBC, U&E, LFT
PSA (total and free)
DRE
TRUS
Isotope bone scan
MRI

Question 6

describe PSA values which indicate a biopsy is needed

Answer 6

<60 years old >3
60-70 years old >4
>70 years olf >5

Question 7

give the cause of major PSA elevation in the absence of prostate cancer

Answer 7

UTI

Question 8

give some causes of a raised PSA in the absence of prostate cancer

Answer 8

BPH
UTI
TRUS/TRUP
ejaculation/DRE
prostatitis
catheterisation

Question 9

in the presence of infection or instrumentation, PSA should be repeated after how long?…

Answer 9

minimum 28 days

Question 10

how long post ejaculation should you wait before doing a PSA

Answer 10

48 hours

Question 11

describe the sensitivity of PSA and what it means for the patient

Answer 11

sensitivity of PSA is 80%. There is no level of PSA at which prostate cancer can be ruled out

Question 12

who would be a candidate for watchful waiting

Answer 12

men with a life expectancy of <10 years

Question 13

what is active surveillance

Answer 13

patients are monitored with regular PSA, DRE and TRUS bx

Question 14

give the GnRH analogue most commonly used in androgen deprivation

Answer 14

goserelin