Prostate Ca

Question 1

T1/2

Answer 1

localised prostate cancer

Question 2

T3/4

Answer 2

locally advanced prostate cancer

Question 3

Treatment options for T1/2 prostate ca

Answer 3

• conservative: watch and wait
• radical prostatectomy
• radiotherapy: external beam and brachytherapy

Question 4

Treatment options for T3/4 prostate ca

Answer 4

• hormonal therapy
• radical prostatectomy
• radiotherapy (external beam /brachytherapy)

Question 5

Complications of prostate ca radiotherapy

Answer 5

• proctitis
• increased risk of bladder, colon, and rectal cancer

Question 6

What hormone are we aiming to reduce in prostate cancer?

Answer 6

androgens

Question 7

What hormone therapies can be used to suppress androgens?

Answer 7

• synthetic GnRH agonist or antagonists
• bicalutamide - non-steroidal anti-androgen which blocks the androgen receptor
• cyproterone acetate - steroidal anti-androgen, prevents DHT binding from intracytoplasmic proteins
• abiraterone
  androgen synthesis inhibitor

Question 8

how do GnRH agonists work?

Answer 8

• paradoxically lower LH levels longer term by causing overstimulation
  => disrupt hormonal feedback

testosterone rises initially for 2-3 weeks before falling

Question 9

Side effect of GnRH agonists

Answer 9

Initial rise in testosterone causes ‘tumour flare’.

=> stimulation of prostate cancer growth may result in bone pain, bladder obstruction and other symptoms

Question 10

How is “tumour flare” with GnRH agonists managed?

Answer 10

Cover first few weeks with an anti-androgen

Question 11

GnRH antagonists do NOT display the “tumour flare” phenomenon. TRUE/FALSE?

Answer 11

TRUE

Question 12

When is a bilateral orchidectomy used in hormal Tx of prostate ca?

Answer 12

To rapidly reduce testosterone levels

Question 13

Upper limits of PSA in 50-59, 60-69 and >70y age groups

Answer 13

50-59 years 3.0
60-69 years 4.0
> 70 years 5.0

Question 14

What other than prostate ca can raise a PSA level

Answer 14

BPH
prostatitis
UTI
ejaculation (in previous 48 hrs)
vigorous exercise (in previous 48 hours)
urinary retention
instrumentation of the urinary tract