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/ yearsPSA level/ ng/ml >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 2 nd 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 PSA27.10  Hb13.1 WCC18.70  neut17.1 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, 3 rd 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?