Prostate cancer

Question 1

What is prostrate cancer?

Answer 1

Prostate cancer is a malignant tumour that arises from the cells of the prostate, a small walnut-sized gland that produces seminal fluid in men

Question 2

What are the risk factors for prostrate cancer?

Answer 2

• Age > 50
• Afro-Caribbean 
• Family history - BRCA:
  BRCA 1 and 2 (breast cancer gene 1 & 2) are non modifiable risk factors more commonly associated with breast and ovarian cancer. However, male carriers are at higher risk of prostate (and breast) cancer
• Dietary factors 
• Occupational exposure to cadmium (by-product of zinc production) 

Question 3

What are the presenting symptoms of prostrate cancer?

Answer 3

• Typically asymptomatic, until it progresses:
• Urinary symptoms, including difficulty initiating or stopping urination
• Poor urine stream
• Haematospermia (blood in semen)
• Pelvic discomfort
• Bone pain, potentially indicating metastatic disease
• Erectile dysfunction

Question 4

What signs of prostrate cancer can be found on physical examination?

Answer 4

Abnormal DRE → asymmetrical, hard, nodular enlargement of prostate, with loss of midline sulcus  

Question 5

What investigations are used to diagnose/ monitor prostrate cancer?

Answer 5

1. Transrectal ultrasound-guided needle biopsy → gold standard. May detect adenocarcinoma. Gleason staging.
   - Multiparametric MRI is now 1st line investigation
2. PSA Levels → not cancer-specific however, as levels may also be elevated in benign conditions (BPH, UTI, prostitis). PSA>4 ng/mL: prostate cancer is likely.
3. DRE
4. Bone Scan → check for metastases (raised ALP if bone mets)
5. Pelvic CT/MRI Scan → can help stage cancer
   - MRI Spine - look for metastases causing spinal cord compression (can lead to incontinence and weakness)
6. Gleason Grading System (Low Gleason Score = better prognosis)

Question 6

How is prostrate cancer managed?

Answer 6

1. Localised Prostate Cancer (Low Grade) → active monitoring and watchful waiting
2. Localised Advanced Prostate Cancer (T3/T4) → radical prostatectomy (ED is a common complication)/ robotically assisted laparoscopic prostatectomy (RALP) Radiotherapy.
   - Can also cause urethral stricture that can cause LUTS (incontinence).
3. Metastatic Prostate Cancer → hormonal therapy-aim to reduce testosterone levels, slowing the progression of metastatic prostate cancer
   - GnRH agonists - goserelin
   *Side Effects = gynaecomastia, decreased libido, impotence, infertility
   - Androgen antagonists ⇒ bicalutamide and enzalutamide
   - GnRH antagonists ⇒ degarelix

Question 7

Describe the prognosis behind prostrate cancer

Answer 7

Prostate cancer is a curable cancer. Biochemical disease-free survival and overall survival depend on initial stage of disease at the time of diagnosis. 

Question 8

Describe the epidemiology of prostrate cancer

Answer 8

2nd most common cancer& 5th leading cause of cancer mortality in men worldwide