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.