Prostate Cancer

Case Presentation

Shireen Siddiqui

Prostate Cancer

Commonest cancer in UK men

Majority are well defined adenocarcinomas

Rare in <50y

Often present with metastases 5 year survival rate approx 30%

Clinical Features

BOO symptoms: Voiding symptoms: hesitancy, poor flow Storage symptoms: frequency, urgency

Haematuria

Back pain

Constipation

General effects of malignancy

Symptoms suggestive of metastases

PSA Ranges

Age/ years PSA level/ ng/ml

50-59 3.0

60-69 4.0

>70 >5.0

No age-specific reference ranges for men over 80 years. Nearly all men of this age have at least a focus of cancer in the prostate. Prostate cancer only needs to be diagnosed in this age group if it is likely to need palliative treatment.

Gleason Staging

5 histological stages of differentiation

Two numbers, most prevalent and the 2nd most prevalent pattern give the Gleason score

5-6 Lower progression rates after definitive

therapy

7-10 Worse prognosis

Treatment

Organ defined: Active surveillance Radical prostatectomy

Locally advanced: Systemic treatment: hormone therapy Radiotherapy LHRH agonist – Zoladex

Metastatic: LHRH agonist Anti-androgen therapy - Bicalutamide Bilateral orchidectomy Chemotherapy

Case History

80 year old male

Fit and well

No PMHx

No DHx

Lives with wife

PC

Urinary urgency and frequency

Wife felt he was more confused

Returned from holiday, drove 1100 miles

Positive urine dip, started on abx

MSU: E. coli

r/v 1 week

1 week later

Confusion had settled

Felt much better

Nocturia, urinary incontinence, poor stream

Usually no LUTS

Ex: DRE: enlarged prostate, irregular on left Abdo: distended, enlarged bladder 1.5l residual

Results

PSA 27.10

Hb 13.1

WCC 18.70

neut 17.1

Repeat MSU: Klebsiella species

2WW Urology

Likely spurious PSA level

Failed TWOC

Arranged cystoscopy: bladder NAD

Prostate biopsies taken

2WW Urology

Prostate Ca confirmed : Gleason 5+4 Commenced on Cyproterone acetate

Bone scan: Metastases to thoracic spine, left iliac crest,

sacrum, 3rd right rib

Currently

Doing well, not needing any analgesia

SRC still in place

On 3 monthly Prostap injections

My learning points

Why does he have a UTI?

Possible bladder outflow obstruction. Enlarged prostate?

Examine abdomen.

2WW Urology Criteria-?Prostate Ca

With a hard, irregular prostate typical of a prostate carcinoma

With a normal prostate, but rising/raised age-specific PSA, with/without LUTS

With symptoms and high PSA levels

Summary

Prostate cancer is the commonest cancer in men in the UK

Can present with LUTS, UTI, no symptoms, but most often with metastases

Consider cause for UTI, ?BOO

Any questions?