Prostate Cancer

Question 1

Where are most prostate cancers found?

Answer 1

Peripheral Zone

Question 2

What are the stages of prostate cancer?

Answer 2

Localized
Locally Advanced
Metastatic
Hormone Refractory (i.e. resistant to castration)

Question 3

Risk factors for Prostate Cancer?

Answer 3

1) Age
2) African/Afro-carribean
3) FH
4) High fat/processed carb diet
5) Some Drugs actually reduce risk e.g. Finasteride

Question 4

How might a prostate cancer present?

Answer 4

Most present with non cancer-specific symptoms, just LUTS & UTIs

Question 5

What symptoms would indicate an invasive prostate cancer?

Answer 5

If it comes with:

• Loin/perineal/suprapubic pain
• Impotence
• Haematuria or haemospermia
• Renal Failure
• Rectal Symptoms

Question 6

What symptoms would indicate a metastatic prostate cancer?

Answer 6

If it comes with:

• Bone Pain or sciatica
• Spinal cord compression (Paraplegia)
• Lymph Node Enlargement
• Lymphoedema
• Loin pain/anuria (lymph nodes obstruct ureters)
• Lethargy due to anaemia or uraemia
• Weight loss & Cachexia

Question 7

So a 65 yr old man presents with frequency, dysuria and slow to start urination. How would you confirm its prostate cancer?

Answer 7

A digital Rectal Exam (hard craggy prostate)

TRUS-guided biopsy (Transrectal US)

Question 8

How do you stage Prostate Cancer?

Answer 8

Prostate Specific Antigen (PSA)
TRUS guided biopsy
CT pelvis, chest/abdo
MRI pelvis

Question 9

What can cause an elevated PSA?

Answer 9

Upper limit increases with age

• UTI
• Chronic prostatits
• Instruments e.g. catheter
• Physiological e.g. ejaculation
• Recent urological procedure
• BPH!!
• Prostate Cancer!!

Question 10

How is Prostate Cancer Treated?

Answer 10

Hormone Therapy:

• Alone
• Intermittent
• Followed by Surgery
• Followed by RT

Question 11

Types of RT for prostate cancer?

Answer 11

External Beam RT

Brachytherapy (Radioactive material inserted directly into the site)

Question 12

What are the major types of Hormone therapy?

Answer 12

Surgical castration (Bilateral Orchidectomy)

Chemical Castration with LHRH analogue

Anti-androgens

Oestrogens

Question 13

How does chemical castration work?

Answer 13

LHRH analogue (e.g. goserelin) downregulates androgen receptors by -ve feedback.
It causes the tumour to flare in the first wk so you need combined anti-androgens

Question 14

How do anti-androgens work?

Answer 14

Inhibit androgen receptors on the Prostate

Question 15

How do oestrogens treat prostate canceR?

Answer 15

1) Inhibit LHRH & Testosterone secretion
2) Inactivate Androgens
3) Direct cytotoxic effect on prostatic epithelium

Question 16

How is prostate cancer graded?

Answer 16

Gleason grading - good for prognosis & tracking treatment

ISUP Grade Groups 1-5