Prostate Cancer

Prostate cancer relies on Androgens to grow. Risk factors for it include:

• Increasing age

• Family hx

• Afro-Caribbean

• Increased testosterone - e.g. use of anabolic steroids

Presentation

May be asymptomatic in early stages, but can present with:

• LUTS (same as BPH) - Frequency, Urgency, Hesitancy, Weak stream, Terminal dribbling, Nocturia

• Blood in urine/semen

• Bone and back pain (suggests metastasis)

• Erectile dsyfunction

N.B. Always ask about bone and back pain in any patient suggestive of prostate ca. to screen for metastasis.

Investigations

• DRE - firm, asymmetrical, irregular, loss of central sulcus

• Urine dip

• PSA

• MRI

• Biopsy

N.B. PSA is unreliable with a high rate of false positives (75%) and false negatives (15%), therefore may lead to unnecessary further investigations or false reassurance.

Management

• Active surveillance if low grade

• Radiotherapy

• Prostatectomy

• Hormonal therapy to reduce testosterone - GnRH analogues (e.g. Goserelin), GnRH antagonists, Androgen antagonists

N.B. In normal endocrine physiology, GnRH is secreted intermittently. Goserelin is a GnRH agonist, therefore increases GnRH secretion, leading to a continual secretion and subsequently disrupting the hormonal axis. This overall results in a reduced secretion of testosterone, which reduces growth of the prostate tumour (less testosterone available to convert to DHT).