Prostate Cancer Case Presentation Shireen Siddiqui.
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Transcript of Prostate Cancer Case Presentation Shireen Siddiqui.
![Page 1: Prostate Cancer Case Presentation Shireen Siddiqui.](https://reader035.fdocuments.net/reader035/viewer/2022062222/56649e625503460f94b5d6eb/html5/thumbnails/1.jpg)
Prostate Cancer
Case Presentation
Shireen Siddiqui
![Page 2: Prostate Cancer Case Presentation Shireen Siddiqui.](https://reader035.fdocuments.net/reader035/viewer/2022062222/56649e625503460f94b5d6eb/html5/thumbnails/2.jpg)
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%
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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
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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.
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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
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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
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Case History
80 year old male
Fit and well
No PMHx
No DHx
Lives with wife
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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
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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
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Results
PSA 27.10
Hb 13.1
WCC 18.70
neut 17.1
Repeat MSU: Klebsiella species
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2WW Urology
Likely spurious PSA level
Failed TWOC
Arranged cystoscopy: bladder NAD
Prostate biopsies taken
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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
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Currently
Doing well, not needing any analgesia
SRC still in place
On 3 monthly Prostap injections
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My learning points
Why does he have a UTI?
Possible bladder outflow obstruction. Enlarged prostate?
Examine abdomen.
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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
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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
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Any questions?