1: Urological Malignancies - Prostate Cancer Flashcards
What is prostate cancer
Adenocarcinoma of the prostate gland
What is the commonest cancer in males
Prostate cancer
Explain incidence of prostate cancer with age
Increases
What are two RF for prostate cancer
Smoking
Increasing age
What is the problem with prostate cancer
As it occurs in peripheral prostate gland (furthers from ureter) it does not cause symptoms until late
How may prostate cancer present
- Hesitancy
- Terminal dribbling
- Poor-Stream
- Nocutira
- Back pain (Mets)
- Weight loss
Explain metastases of prostate cancer
Prostatic venous plexus drains to internal iliac veins. However, it also has a branch to posterior venous plexus (Baston venous plexus) which drains to inner vertebral venous plexus causing early mets to the back
How does prostate cancer present on exam
hard, irregular (craggy) prostate
What lymph nodes does prostate cancer first spread to
Obturator nodes
What two initial investigations are ordered/performed for prostate-cancer
- DRE
- PSA
what is prostate specific antigen produced by
Both malignant and non-malignant cells of the prostate gland
when do NICE recommend individuals should be sent under 2WW for prostate cancer
50-70 and PSA of more than 4
how long after treatment for UTI or prostatitis should you wait before doing a PSA if required
1W
how long should an individual not ejaculate or exercise for if having a PSA test
48h
give 5 causes of raised PSA, aside from prostate cancer
- BPH
- Exercise
- Ejaculation
- Instrumentation tract
- DRE
explain measuring PSA and DRE
Do not mausre PSA immediately after DRE - as it causes false positives
When are men referred under 2WW
50-70 year-olds with
- PSA >4
- and abnormal DRE
If referred under 2WW for prostate cancer what is now first-line investigation
Multiparametric MRI
If an individual scores more than 3 on multi-parametric MRI what is offered
Trans-rectal US and biopsy
If an individual scores 1-2 on multi parametric MRI what Is done
Consider TRUS and biopsy depending on:
- DRE
- PSA
- RF
what is used to stage prostate cancer
Multiparametric MRI
what investigation is used to grade prostate cancer
Transrectal US and biopsy
what scoring system is used to grade prostate cancer
Gleason scoring system
explain gleason scoring system
Most common type of cell is given a score 1-5. The second most common type is given a score 1-5. These are added together to give score 2-10.
10 = worst prognosis
how can T1-T2 prostate cancer be managed
- Watchful waiting
- Prostatectomy
- Radiotherapy (Brachytherapy, External-Beam)
how can T3-T4 prostate cancer be managed
- Hormonal
- Radiotherapy
- Radical prostatectomy
what is a complication of prostatectomy
Erectile dysfunction
what is a complication of brachytherapy or external-beam radiotherapy in prostate cancer
colon, bladder and rectal cancer
what is given to manage metastatic prostate cancer
gosrelin
what is gosrelin
GnRH agonist
what needs to be given with gosrelin first and why
have to give with a anti-androgen initially to protect against effects of rise in testosterone
what is an anti-androgen
cytoproterone acetate
what is the flare effect
during initial stages of treatment with gosrelin it can worsen symptoms due to increase in LH prior to receptor down-regulation
what can be given to reduce flare effect
flutamide
how long should you wait after DRE before doing a PSA
1-week
