Explain what prostate and prostate cancer – (draw a diagram) first; the prostate is a walnut sized gland that forms part of the male reproductive system. It secretes fluid that carries sperms. It surrounds the urethra or the canal, which carries urine from the bladder out of the body.
prostate cancer is one of the most common cancer in men. It is rare before age of 50 and increasing incidence with age. There is a family connection similar to breast cancer in women. It is considered to be a slowly growing cancer and can be asymptomatic even if extended beyond the prostate or can cause symptoms like.
What are the screening guidelines for prostate cancer?
Screening of men without symptoms is controversial
It is recommended after 40 years of age in men with a positive family history.
There is no national screening program in most countries, including Australia.
However, men should make their own decision after being fully informed of the potential benefits, risks and uncertainties of testing.
It is of limited value after 70 years and not advisable after 75 years
How do you interpret PSA level?
PSA 6 ng/ml-10 ng/ml high
How is prostate cancer diagnosed?
There are a few key tests to diagnose prostate cancer namely: digital rectal examination (digital rectal examination)-a doctor using a gloved finger may feel if the prostate is enlarged, hard or unusual prostatic-specific antigen(PSA) test
this special blood test if elevated may Indicate the presence of cancer biopsy
several samples of prostate tissue are taken with ultrasound guidance in the rectum and examined in the laboratory.
First there is a Gleason grade to help determine how quickly is the cancer to grow and how likely to spread outside the prostate. This ranges from 1 to 5 given based on the appearance of the cancer cells.
1 is when the cells look much like normal and 5 indicates a very abnormal and aggressive cell type
then the pathologist add the two most common grades together to make a final [[Gleason score]] , so a total of rating from 2 to 10 is given.
How do you correlate gleason score with psa grades?
Fast-growing cancers which are more likely to affect a man‘s health and lifespan are called highgrade cancers‘ with a Gleason score of 7 to 10.
High grade cancers usually need to be treated more radically, either by surgery or radiotherapy, since they grow more quickly and may spread to other parts of the body.
Gleason score
2–6 Low,
7 Intermediate,
8–10 High!
Explain the TNM staging of prostate cancer.
T1-The tumour is found only in the prostate. It cannot be felt during a digital rectal examination.
T2-The tumour is located within the prostate only. It can be felt during a digital rectal examination.
T3-The tumour has spread from the prostate to nearby tissues such as the seminal vesicle glands, which produce semen.
T4-The tumour has spread beyond the prostate to the bones or lymph nodes.
N1-3 means the cancer has spread to the lymph nodes (glands) near the prostate. N0 means the cancer has not spread to any lymph nodes.
M followed by 1a, b or c shows that the cancer has spread to the bones or other organs of the body
How will you explain grading and staging in prostate cancer?
Grading and staging
A good way of explaining to patients about grading and staging is to saythe grade is how aggressive the cancer is, and the stage is how much there is and how far it has spread
From the biopsy, the pathologist determines the grading using the Gleason score (see TABLE 116.2 and FIG. 116.4).
The score is based on the addition of the grading of the 2 most common types of cells found in the samples(graded from 1, being well differentiated, to 5, most dysplastic).
Therefore the lowest score possible is 2 and the highest 10.
Prognosis is also determined by the ratio of the higher of the two histological scores(e.g. Gleason 7 with 80% stage 4/20% stage 3 will be worse than Gleason 7 with only 20% stage 4/80% stage 3)
What are the management options in prostate cancer?
now the good thing is that we picked it up early so it can be managed properly.
treatment will be by a MDT including urologist, cancer specialist and GP.
urologist will decide upon the treatment. Options depend on age, PSA level, Gleason score and staging.
Options are:
Watchful waiting: usually for those > 70 years old and asymptomatic
Active Surveillance: Which is almost same as watchful waiting but you also do prostate biopsies
usually for tumour that confined to prostate and if patient is under 70 years with a PSA level < 20ng/ml. It offers 90% 10 year disease-specific survival for organ-confined tumours. [[incontinence]] rate is about 7% and [[impotence]] rate at least 30% or up to 70% (different authors).
All these have significant side effects ranging from an initial testosterone surge to loss of muscle mass, OSTEOPOROSIS, Anaemia, hot flushes and adverse cognitive changes.
Specifically, in this patient the PSA is only slightly elevated and the biopsy has confirmed a cancer with low aggressiveness and there is no further spread of the tumour.
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