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Prostate cancer

Definition
  • Prostate cancer: A malignant tumour that originates in the prostate gland, typically in the peripheral zone.
Epidemiology
  • Most common cancer in men in the UK.
  • Risk increases with age, especially after age 50.
  • Higher prevalence in black men and those with a family history.
Pathophysiology
  • Most are adenocarcinomas (arising from glandular cells).
  • Genetic mutations, hormones (especially testosterone), and inflammation are implicated in development.
Clinical Presentation
  • Often asymptomatic in early stages.
  • Lower urinary tract symptoms (LUTS): Difficulty urinating, frequency, nocturia.
  • Erectile dysfunction.
  • Hematuria or haematospermia.
  • Bone pain if metastasised.
Investigations
  • PSA testing: Elevated in prostate cancer, but also other conditions like prostatitis.
  • Digital rectal examination (DRE): Prostate may feel hard or irregular.
  • Prostate biopsy: Confirms diagnosis and grades the tumour.
  • MRI and bone scans: Evaluate spread.
Management
  • Depends on staging, grade, and patient’s health and age.
  • Active surveillance for low-risk cancers.
  • Prostatectomy for localised cancers.
  • Radiation therapy: External beam or brachytherapy.
  • Androgen deprivation therapy for advanced cancers.
  • Chemotherapy in metastatic cases.
Prognosis
  • Generally good for localised prostate cancer.
  • Depends on Gleason score, PSA levels, and stage at diagnosis.
Complications
  • Metastasis to bones, lungs, and liver.
  • Urinary incontinence and erectile dysfunction post-treatment.

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