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UROLOGY > 3: Prostate Cancer > Flashcards

3: Prostate Cancer Flashcards

1
Q

what is the epidemiology of carcinoma of the prostate

A
  • commonest cancer in men
  • rare in men <50
  • 2nd commonest cause of death from cancer in men
  • majority are adenocarcinomas
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2
Q

what are the risk factors of carcinomas of the prostate

A
  • inc age
  • family history and BRACA2 gene mutation
  • ethnicity (black –> white –> asian)
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3
Q

label the zones of the bladder

A
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4
Q

what zone of the prostate is carcinoma most commonly found

A

peripheral zone
(compared to more central zone of BPH)

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5
Q

what do patients present with in prostate carcinoma

A
  • symptoms of UTI
  • LUTS: weak urinary stream, increased urinary frequency and urgency
  • prostatism or metastatic disease of the bone causing bone pain, haematuria, dysuria, suprapubic or loin pain
  • raised PSA in otherwise asymptomatic men, biopsy
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6
Q

how can carcinoma of the prostate be found

A
  • opportunistic finding from DRE: evidence of asymmetry, nodularity or fixed irregular mass
  • incidental finding at transurethral resection of the prostate
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7
Q

what can cause a raised PSA

A
  • prostate cancer
  • infection
  • inflammation
  • large prostate
  • urinary retention
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8
Q

does a normal PSA always indicate an absence of prostate cancer

A

no - you can have a normal PSA but an abnormal feeling prostate on DRE

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9
Q

how is prostate carcinoma graded

A

Gleason classification - grades tumours on histological appearance
- grade 5: anaplastic diffuse tumour with cells showing great variation in their structure and high mitotic rate
- grade 3-5
- biopsy = sum of 2 highest scores
- radical prostatectomy = 2 most prevalent scores
- low = Gleason 3+3=6
- intermediate = 3+4=7
- high= 4+3=7, 8,9,10

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10
Q

how is prostate carcinoma staged

A

TNM following CT chest-abdo-pelvis and PET-CT nuclear medicine scan
- T1: unsuspected impalpable tumour
- T2 : the tumour is confined to the prostate
- T3 :there is local extension of the tumour beyond the prostatic capsule
- T4: the tumour has fixed to other structures

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11
Q

how is prostate carcinoma diagnosed

A
  • DRE: hard, irregular prostate
  • US: prostatic mass
  • inc PSA in blood: normal result does not exclude the presence of cancer
  • biopsy: used to provide a histological diagnosis
  • radiographs and bone scans: used to stage the tumour
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12
Q

what feature is present in advanced prostate cancer

A
  • osteosclerotic lesions (seen on radiographs)
  • inc isotope uptake on bone scans seen as ‘hot spots’
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13
Q

what is the treatment for localised prostate cancer

A
  • depends on the stage of the tumour
    surgery
    hormone therapy
    radiotherapy
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14
Q

before treatment for prostate cancer starts, what needs to be done

A

histological diagnosis of prostatic carcinoma is required as treatment depends on the stage of the tumour
- T1/T2 radical surgical resection of the prostate (or radical prostatectomy) may be curative. TURP may be required
- Local radiotherapy can be used if the patient is unfit for surgery, and to treat localordistant spreadofthetumour
- Surveillance

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15
Q

what are the side effects of a prostatectomy

A
  • urinary incontinence
  • erectile dysfunction
  • infertility
  • bladder neck stenosis
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16
Q

what are side effects of RT in localised prostate cancer

A
  • discomfort around RT site
  • diarrhoea
  • loss of pubic hair
  • tiredness
  • inflammation of bladder lining
  • erectile dysfunction (impotence)
17
Q

what are some emerging treatments for prostate cancer

A
  • Brachytherapy
  • High-Intensity Focused Ultrasound (HIFU) –uses ultrasound waves to target and destroy cancerous prostate tissue, sparing nearby structures
  • Cryotherapy – cryoneedlesinserted into prostate gland through wall of rectum. Freeze prostate gland
18
Q

describe treatment of advanced prostate cancer

A
  • Advanced tumours: hormonal manipulation is beneficial since testosterone promotes tumour growth
    - Testosterone
    - Dihydrotestosterone
  • Surgical castration
  • Medical castration
    - LHRHagonists
    - GnRH agonists
  • Palliative care
19
Q

what are some side effects of castration

A
  • hot flushes
  • impotence
  • thinning of bones
  • diminshed muscle mass
  • inc in breast size
  • weight gain
  • mood changes
  • testosterone suppressed
20
Q

what is the prognosis of prostate cancer

A

depends on stage
- 5 year survival rate for T1 tumours = 75-90% but this falls to 30-45% if there is local or metastatic spread

21
Q

what are the 2 types of prostate adenocarcinoma

A
  • acinar: originates in glandular cells that line prostate gland
  • ductal: originate in cells that line the ducts of prostate which tends to grow and metastasise faster
22
Q

what is PSA

A

serum protein that is produced by both malignant and normal healthy cells in prostate gland

23
Q

what are normal age-adjusted serum PSA levels

A
24
Q

what is the function of PSA

A
  • dissolution of the seminal fluid coagulum
  • important role in fertility
25
Q

what are the overall risks and benefits of PSA screening for prostate cancer

A
  • significant reduction in prostate cancer mortality at 11 years
  • over diagnosis and over treatment
26
Q

what is the current standard method for diagnosing prostate cancer

A

biopsy of prostatic tissue
1. transperineal: template biopsy or freehand guided by both intra-procedure USS and mpMRI (decreased risk of infection)
2. TransRectal UltraSound-guided biopsy (TRUS): sample prostate transrectally using us then sample in systematic manner

27
Q

what is waitful watching

A

symptom-guided approach to prostate cancer management where therapy is deferred and initiated at time of symptomatic disease
- generally reserved for older pt w lower life expectancy
- can be offered at any stage
- largely guided by patient goals and maintaining QoL

28
Q

what is active surveillance

A

monitoring of pt w 3-monthly PSA, 6-12 monthly DRE and re-biopsy at 1-3 yearly intervals
- assessing for progression and intervening at appropriate time
- low risk disease

29
Q

what is the mainstay surgical treatment for prostate cancer

A

radical prostatectomy: removal of prostate gland, resection of seminal vesciles +/- tissue dissection of pelvic lymph nodes
- open, lap, robotic

30
Q

what does external-beam RT and brachytherapy involve

A

curative intervention for localised prostate cancer
- brachytherapy: transperineal implantation of radioactive seeds (Iodine-125) directly into the prostate gland
- external beam: uses focused radiotherapy to target prostate and limit damage to surrounding tissues

31
Q

what is the mainstay of management of metastatic prostate cancer

A

androgen deprivation therapy (ADT)
- prostate cancer cells will undergo apoptosis when deprived of testosterone
- anti-androgens e.g. bicalutamide for 28 days
- GnRH receptor agonists e.g. goserelin and antagonsists e.g. degarelix
- surgical castration
- enzalutamide and abiraterone lower levels of serum T
- chemo: docetaxel or cabazitaxel

32
Q

what is castrate-resistant disease

A
  • rising PSA despite hormone therapy
  • dexamethasone
  • docetaxel chemo
33
Q

what is the current 1st line investigation in suspected prostate cancer

A

multiparametric MRI

UROLOGY (8 decks)

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