11b.) Prostrate Cancer Flashcards
What is the commonest cancer in men?
Prostrate
Is the incidence of prostrate cancer increasing or decreasing?
Increasing
Nearly every man in their 80’s has prostrate cancer; true or false
True but:
- Most don’t know they have it
- Most don’t need to know they have it
- Most die with it, not from it
Challenge is to identify men who will come to harm from prostrate cancer
State some risk factors for prostrate cancer
- Age
-
Family history
- If 1st degree relative diagnosed with prostrate cancer before 60 increases risk x4
- BRCA2 gene mutation
- Ethnicity (black > white > asian)
Do we do mass population screening for prostrate cancer?
- No
- Reccommended we do opportunistic screening e.g. if patient presents with associated symptoms, have family member with prostrate cancer, have read about PSA
What is PSA test?
Prostrate specific antigen test
State some issues with PSA screening/why we don’t do it
- Over-diagnosis
- Over-treatment
- QoL
- Co-morbidities of established treatments
- Cost effectiveness
- Other causes of raised PSA: infection, inflammation, large prostrate, urinary retention
Having a normal PSA means you do NOT have prostrate cancer; true or false
FALSE- having a normal PSA does not mean you do not have prostrate cancer/can have prostrate cancer and have normal PSA. You can have a normal PSA but an abnormal feeling prostrate on DRE
You can’t rely on a PSA within 6 weeks of a urinary infection; true or false?
TRUE
Describe the symptoms of prostrate cancer
- Urinary symptoms:
- frequency, urgency
- hesitancy
- feeling that bladder not emptied properly
- haematuria
- blood in semen
- Bone pain
Prostrate cancer is sometimes discovered accidentally; state some circumstances in which prostrate cancer may be discovered accidentally
- DRE for another reason e.g. change in bowel habit
- Incidental finding at transurethral resection of prostrate (TURP) for retention/urinary symtpoms
What is TURP?
- Transurethral resection of prostrate
- Instrument inserted into urethra and used to cut away section of prostrate for urinary/retention symptoms
Treatment of prostrate cancer depends on extent of cancer; state some investigations that allow us to determine the extent of prostrate cancer
- Age
- DRE
- Localised (T1/T2)
- Locally-advanced (T3)
- Advanced (T4)
- PSA level
- Biopsies
- Gleason grade: low magnification grading (score 6-10)
- Extent
- MRI and bone scan (identify nodal and visceral metastases)
How do we treat localised prostrate cancer?
- 1st choice: surveillance
If need treatment:
- Robotic radical prostratectomy
- Radiotherapy:
- External beam
- Brachytherapy (put radioactive seeds into prostrate)
How do we treat locally advanced prostrate cancer?
- Surveillance
- Hormones
- Hormones & radiotherapy
Can prostrate cancer cause bone metastases? What is interesting about these bone metsastes compared to other cancer metastases in bone?
Yes, the bone metastases are osteoblastic (sclerotic) which is unusual as bone metastases are usually osteoclastic
How do we treat metastatic prostrate cancer?
- Hormone treatment +/- chemotherapy (hormones lower mans testosterone to castration levels= medical castration using LNRH agonists)
- Palliation care:
- Single dose radiotheray
- Bisphosphonates e.g. zoledronic acid
- Chemotherapy
- New treamtents
You must do both PSA and DRE; true or false?
True
How do you diagnose prostate cancer/
- DRE
- Serum PSA
- Biopsy (usually of peripheral zone)
- MRI
What might you see on bone scan of someone with prostrate cancer?
“hot spots” on bone scan
