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Hello, everyone. Uh Thanks for joining this evening. We'll just wait like a minute or two for everyone to join. Then we'll get started. Thank you. Great. I think we might as well get started. So thank you for joining this evening. Uh Today's session is on prostate cancer. So basically, what we're trying to cover today is a bit about how prevalent prostate cancer is and why it's important to learn about it. Some of the risk factors, the pathophysiology behind it, what you should do if you suspect prostate cancer and a bit about diagnosis and management and it's quite useful for MCQ and obviously quite common. Um in clinical practice, I think it'll be quite useful for you guys. So just a quick warm up. Um Just a bit of a question for you guys if you'd like to put in the chat or speak out how many cases of prostate cancer do you think there are diagnosed per year in the UK? Like a rough estimate? You can put it in the chart if you'd like. I the 1000 actually quite a bit more but good guess. Um So prostate cancer is the most common cancer in men in the UK. And they diagnose roughly like 50,000 cases per year. So it's actually like a major, major thing. Um Roughly one in eight men will be diagnosed in their lifetime and it causes roughly 12,000 deaths per year. It mainly affects older men. Um So that's why it's not so popular or that's why people don't see about it so much in the mainstream media. But it is quite a big problem. And when you work in a hospital, you know, hospitals are quite full of elderly patients. So a lot of elderly men, you have will, you know, be undergoing diagnosis or have been diagnosed with it. It's quite a big problem. Um I thought we first talk a bit about what's the prostate and then start diving into what goes wrong. So the prostate, it's a gland involved in reproduction and the way it works is it secretes enzymes um into semen that prevent it from clotting, it breaks down clotting factors and weeps it of fluid and this helps um in reproduction. And if I can show you the diagram on the next page as an organ, it sits just below the bladder and surrounds the urethra. And that's quite useful when we think about, you know, approaches to surgery biopsy. Um and also the symptoms it can cause. So risk factors for prostate cancer. The most important one is mainly increasing age. It's a disease that's seen most commonly in elderly gentlemen, quite rarely in younger people, other risk factors for prostate cancer. Uh If you have a family history of it, like a first degree relative, it goes up, um, obesity and also ethnicity. Um So have shown it's a higher risk in Afro Carribean men. So you mentioned family history and it's good to talk about the genetics by prostate cancer. So there's no single gene that is responsible. So you can't look at one in particular, but there are many genes implicated. So there are many genes kind of working together to cause it. You might have heard of bra one and B2, which you commonly see in breast cancer, they've shown associations with prostate cancer. And if you have a male patient presents to you with a first degree relative who has prostate cancer, then your patient has twice the risk of the general population. So that's why it's quite important when you take a history to ask about it because it's just such an increased risk. Patients who have hereditary prostate cancer will typically in their family, like a hereditary disease will often have a worse cancer. So it's more advanced or it has an earlier onset. So it's a bit about the genetics in terms of what it actually is, prostate cancer is just an adenocarcinoma. So once you get mutation of the prostate glandular cells, that's where you get the cancer. Um most importantly about prostate cancer, it's very common for it to metastasize to the bone and lymph nodes. And this is important because any time you have a patient with a history of prostate cancer and they present with symptoms like back pain or bone pain, you have to have it in the back of your head that it could be a metastasis. Mhm. So, we've talked a bit about, you know, it's, it's quite a big problem. It affects quite a lot of men. You know, it can be hereditary risk factor, include increasing age and obesity. But what do you think some of the symptoms of prostate cancer are if you like to put them in the chat there? Anything you can think of? No? Yeah. Ok. Ok. Lower tract symptoms. Yep. That's correct. So it can cause symptoms similar to BPH, mainly because if you have a cancer it presses on the urethra. And so you get symptoms like the frequency retention and urgency. But most importantly, with prostate cancer, you have to be aware of it. It can be asymptomatic. So, while the cancer develops, if it's not big enough, you can essentially have no symptoms whatsoever. Um, and that's why, you know, it's a thing that can sometimes be missed and, you know, you can get men presenting with quite late stage disease. So that's something you always have to bear in mind that it can be asymptomatic. But like Zain mentioned, um you can get similar symptoms to benign prostatic hyperplasia. So, you know, frequency, urgency, retention, poor flow. I don't think you can get as hematuria because, you know, as cancers develop, uh they build up their own blood supply, which is normally um very disorganized and poor quality blood vessels. So you can get bleeding. Um some of the symptoms you can get, it's a difficulty achieving an erection or painful ejaculation. And I mentioned earlier that in the past physiology that prostate cancer is quite likely to metastasize to bone, anyone presenting with back pain or bone pain or particularly metastatic cord compression. And that would present with symptoms, you know, like in cord quina, those things you have to watch out for as well. And just so, you know, that in case someone comes in with cord compression and they have a background of prostate cancer as an emergency, which would need steroids and radiotherapy. The main thing to w to look out for is it can be asymptomatic. So we've talked about it and, you know, we've seen that it can present, you know, without any symptoms, but assuming someone presents with weight loss and BPH symptoms and they've got a family history of prostate cancer. What kind of things would we do to diagnose someone? Like, do you have any ideas what investigations we'd order or anything like that? PSA blood test? Very, very good. Thank you.