ProstateCa in afya

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second most common cancer in adult males in UK 
most common malignant condition in men over 65 years.

''Risk factors''
    increasing age
    Afro-Caribbean ethnicity

''Features''
    bladder outlet obstruction: hesitancy, urinary retention
    haematuria, haematospermia
    pain: back, perineal or testicular
    digital rectal examination: asymmetrical, hard, nodular enlargement with loss of median sulcus

''Management''

''Localised prostate cancer (T1/T2)''
Treatment depends on life expectancy and patient choice
    conservative: active monitoring & watchful waiting
    radical prostatectomy
    radiotherapy: external beam and brachytherapy

''Localised advanced prostate cancer (T3/T4)''
    hormonal therapy: see below
    radical prostatectomy
    radiotherapy: external beam and brachytherapy

''Metastatic prostate cancer disease'' - hormonal therapy
//Synthetic GnRH agonist//
    e.g. Goserelin (Zoladex)
    cover initially with anti-androgen to prevent rise in testosterone (tumour flare via LH release) - start Cyproterone 3/7 before Zoladex
//Anti-androgen//
    cyproterone acetate prevents DHT binding from intracytoplasmic protein complexes
//Orchidectomy//

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