Prostate

Question 1

Most common type?

Answer 1

Adenocarcinoma (95%)

Question 2

RF

Answer 2

BRCAII and pTEN genes

Question 3

Clinical presentation

Answer 3

Most = aysmptomatic

Prostatism - intermittent stream, frequency, dribbling

Metastatic - bone pain, SCC

Question 4

Investigations

Answer 4

1. Routine DRE (lump and obliteration of medial sulcus)
2. Biopsy = diagnostic
3. PSA
   - low levels indicate radical surgery
   - v. high levels indicate occult metastases
4. Radionuclide imaging
5. MRI

Question 5

Staging

Answer 5

T1 = clinically unapparent tumour
T2 = confined to prostate capsule
T3 = extracapular extension
T4 = Tumour fixed to adjacent structure

N1 - local node involvement

Question 6

Management

Answer 6

1. Observation for T2 or less
2. Surgery
   - radical if T2 or less (SE = impotence, incontinence)
   - Palliative to relieve Sx
3. Radiotherapy (external beam and/or brachytherapy)
   - Radical if T1/2 and no occult mets i.e. not v. high PSA
   - Adjuvant - post-op
   - Palliative
4. Hormonal
   - LHRH agonists - inhibit prostaglandin release –> reduced testosterone (SE = reduced libido and impotence)
   - Anti-androgens
5. Chemo - docetaxel + prednisilone + cabazitaxel

Question 7

Prognosis indicators

Answer 7

PSA - increased = poor prognosis
Post-surgery = 80-90% 10yr survival
Metastatic disease = 2.5 yrs