Prostate Cancer Case Presentation Shireen Siddiqui.
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Transcript of Prostate Cancer Case Presentation Shireen Siddiqui.
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?