Prostate Cancer

What are some proven risk factors for prostate cancer?

• Age

• Family history

• Ethnicity

• Diet

• Obesity

• STIs

• Black Caribbean and African men have 2-3x higher risk of

• Relative with cancer

Where does the prostate gland sit?

Base of the bladder surrounding upper part of urethra

What is the function of the prostate?

Stores and secretes name rich fluid that makes up 1/3 of ejaculate volume, liquifies semen and protects sperm during fertilisation

What are the symptoms of prostate cancer?

• Frequency and difficulty in urinating e.g., hesitancy, poor urinary stream and incomplete emptying

• Haematuria - blood in urine

• Nocturia

• Weight loss

• Bone pain

• Anaemia

What can symptoms of localised prostate cancer be similar to e.g., symptoms such as frequency and difficulty in urination and blood in urine?

BPH - benign prostatic hyperplasia

What can occur if BPH is left untreated?

Bladder obstruction

What is the key investigation for diagnosing prostate cancer?

Digital rectal examination

What blood test can be indicative of prostate cancer in primary care?

High prostate specific antigen

What can be indicated if cancer is suspected due to a raised PSA and findings of the digital rectal exam?

Transrectal ultrasound guided biopsy

How is prostate cancer staged?

Gleason score, PSA result and TNM

What is the Gleason score based on?

Microscopic appearance of biopsy tissue from 2-10

What does a higher Gleason score mean?

More abnormal appearance, more aggressive cancer and worse prognosis

What should normal PSA levels - prostate specific antigen - be for men age 50-59?

Under 3ng/ml

What should normal PSA levels - prostate specific antigen - be for men age 60-69?

Under 4ng/ml

What should normal PSA levels - prostate specific antigen - be for men age 70+?

Under 5ng/ml

What is the aim of prostate cancer treatment?

Prevent mortality and morbidity and keep side effects to minimum

What is treatment efficacy complicated by in prostate cancer?

Side effects affecting QOL e.g., erectile dysfunction, urinary incontinence

What are some options for treating prostate cancer?

• Watchful waiting and active surveillance for low risk

• Surgery

• Radiotherapy - in early and metastatic cancer

• Hormone therapy

• Chemotherapy

What are the surgical options for treating prostate cancer?

• Prostatectomy - removal of prostate

• TURP - Transurethral resection of prostate - base of prostate removed

• Orchidectomy - removal of testes

Why is radiotherapy used for prostate cancer in the advanced metastatic phase?

Treat painful bone metastases

When is chemotherapy an option in prostate cancer?

Advanced hormone refractory disease

What therapy is used in prostate cancer to reduce circulating testosterone levels which are the key growth factor for prostate cancer?

Androgen deprivation therapy

How is androgen deprivation therapy usually done?

Surgical or chemical castration

How is chemical androgen deprivation therapy done?

Gonadorelin analogues, gonadorelin-releasing hormone antagonists e.g., degarelix and anti-androgens

How does gonadorelin work to increase testosterone?

• Secreted by hypothalamus and acts on pituitary land

• Causes LH and adrenocorticotropic hormone secretion

• Acts on testes and increases testosterone

What are examples of gonadorelin analogues that work to bind irreversibly tor receptors and prevent further activation, where constant admin prevents LH release?

Goserelin, leuprorelin

What medicinal forms are gonadorelin analogues available in?

Depot intramuscular or subcutaneous injections

What are examples of anti-androgens which work by blocking androgen receptors on cell surfaces and block effects of testosterone and reduce production of testosterone?

Cyprotene, bicalutamide

What are some other hormonal agents used in metastatic hormone-relapsed prostate cancer?

Abiraterone, enzalutamide, apalutamide

What can the issue be with hormone therapy in prostate cancer?

Resistance develops as disease progresses = poor prognosis

What is the gold standard chemotherapy agent for hormone refractory patients with a poor prognosis where the aim is to increase QOL, prolong life and slow disease progression?

Docetaxel

What other chemotherapy agent can be used for prostate cancer resistant to hormone therapy?

Cabazitaxel