(GP) (Musculoskeletal) (Cancer)

Overview

• A malignant tumour of glandular origin (adenocarcinoma), situated in the prostate
• 2nd most common cancer & 5th leading cause of cancer mortality in men worldwide
• Risk Factors → age >50 yrs, family history, black/african ethnicity, BRCA 1 and 2

Making Diagnosis

Clinical Features:

• Typically asymptomatic
• May present with complicated LUTS → urinary retention, haematuria, incontinence, flank pain
• Advanced prostate cancer → fatigue, weight loss, bone pain, neurological deficits, lymphedema
• Abnormal DRE → asymmetrical, hard, nodular enlargement of prostate, with loss of midline sulcus

Investigations:

• Transrectal ultrasound-guided needle biopsy → gold standard. May detect adenocarcinoma. Gleason staging.
  • Multiparametric MRI is now 1st line investigation
• PSA Levels → not cancer-specific however, as levels may also be elevated in benign conditions (BPH, UTI, prostitis). PSA>4 ng/mL: prostate cancer is likely.
• DRE