PROSTATE CANCER

QUES: 55 yr old man who initially presented to your GP with frequency, urgency and pain
when passing urine was referred by you to a urologist because you found on the pr
examination an enlarged prostate.
The urologist sends you a letter with the results of a range of investigations he has initiated:
1. MSU showed growths of e.coli
2. PSA 6 ng/ml ( <4ng/ml normal, 4-6 ng/ml intermediate, >10 ng/ml high)
3. The core biopsy with 8 samples from the prostate was positive for
adenocarcinoma
4. Gleason grade 7
5. A cystoscopy did not reveal a bladder neck obstruction
6. the whole body radioisotope scan did not show metastases
7. CT pelvis and spine did not show any tumour outside the prostate capsule (stage
T2)
The urologist mentions that he explained to patient that there was cancer but he
suggested to see you for further counseling.
Tasks:
1. Explain results and its implications
2. Discuss treatment options
❑ EXPLAIN:
❑ Greet the patient .
❑ How are u doing ? I am really sorry to hear about your cancer. I can only imagine what
you r going through but I want to say that we will be with you every step of the way and I
will arrange every possible support for you.
❑ before I proceed do you have any question.
❑ He said he needs more explanation as he went blank the moment the urologist
mentioned cancer , also he wants to know about gleason score.
❑ Alright, I will explain everything in detail, if u don’t understand at any point pls don’t
hesitate to stop me.
❑ draw prostrate with the kidney, ureter and bladder.. explain that it is a walnut shaped
organ which produces a part of semen. You have the cancer in this organ.
❑ good thing is that the growth is only within the prostate. It has not been spreading to
other parts of your body. First thing to spread is the bone, nearby structures and it can go
to Lungs too. But in case of you it’s nothing like that. That’s a good thing because with
appropriate mx you can be managed very effectively.
❑ We did biopsy from the Gland that means we examined it under microscope &
pathologist scored it accordingly. Its called Gleason score-The Gleason Score is the
grading system used to determine the aggressiveness of prostate cancer. Typical Gleason
Scores range from 0-10. The higher the Gleason Score, the more likely that the cancer
will grow and spread quickly. In your case its 7 which indicates its moderately aggressive.
❑ We examined you with an instrument called cystoscope. From the picture we can see if
the size of the prostate increase in certain point it can obstruct the urine flow from the
bladder to urine tube. In case of you, it’s nothing like that. However, we found some
growth of bacteria/ bugs in your urine which needs medications/ antibiotic.
❑ Implications :
1. first of all, it can grow more and obstruct the urinary flow.
2. Secondly, it can spread to nearby structures, bones lungs etc.
3. 3rdly, it can bleed in urine sometimes if the cancer cells invade the blood vessels nearby.
❑ Treatment options:
❑ I’m going to refer you back to the urologist who will discuss the detailed treatment plan for
you. But I am gonna talk about the options we got –
❑ as its a very slow growing tumor and in case of you it’s contained within the gland. We can just
wait and see. Sometimes it becomes static and never spreads. So, urologist might consider this
option upon your consent. He will examine you frequently and do blood test even biopsy to
see if its growing more or not.
❑ And other option is doing surgery and taking out the gland as a whole what call radical
prostatectomy. It has some side effects and complications too. many men will have temporary
urinary incontinence (loss of bladder control). Almost all men will have a change to their sexual
function and most men will have erectile dysfunction (impotence) but these are temporary,
with time these will be normal again.
❑ Brachytherapy: A radioactive implant is placed inside the prostate to destroy cancer cells. The
implant may be temporary or permanent.
S/E: erectile dysfunction and bowel problems can occur. Some men may experience painful
urination and irritation of the bladder for several months after therapy.
❑ Hormone therapy: This reduces testosterone, which is necessary to help the cancer grow.
Sometimes removal of the testicles is used to cut hormone levels.
side effects may include erectile dysfunction, tiredness, mood changes, hot flushes and loss of sex
drive.
❑ Please don’t get scared, these are all just the possibilities, not everyone get the side effects.
With experienced surgeon and proper technique most of the complications can be avoided
very effectively
❑ Give lots of reassurance
❑ Family involvement
❑ Support group
❑ Psychologist referral
❑ Regular f/u
❑ Reading materials