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Semester 3 - urinary > 31. Carcinoma of the prostate > Flashcards

31. Carcinoma of the prostate Flashcards

1
Q

What is the epidemiology of prostate cancer?

A
  • Commonest cancer in men
  • 2nd commonest cause of death from cancer in men
  • 1 in 8 men will be diagnosed with prostate cancer during their lifetime
  • Incidence is increasing
  • It is rare in men aged <50
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2
Q

WHat are the risk factors for prostate cancer?

A 
↑age
• Family history
- 4x ↑risk
• if one 1st degree relative diagnosed with prostate cancer before age 60
- BRCA2 gene mutation
• Ethnicity
- Black > White >Asian
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3
Q

which part of the prostate are lesions most commonly found?

A

• Lesions are most commonly found in the peripheral zone of the posterior part of the prostate compared with the more central location of BPH

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4
Q

Is there a mass screening for prostate cancer?

A

No

- supports opportunistic screening if patients are counselled

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5
Q

When might a patient be screened for prostate cancer?

A
  • When they present with associated symptoms

- When they come to discuss about a family member who has prostate cancer or because they have read about PSA

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6
Q

What is tested for in screening of prostate cancer?

A

PSA in the blood

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7
Q

What are the issues of PSA screening?

A

• Over-diagnosis (wouldn’t kill them anyway)
• Over-treatment (side-effects)
• QoL
- Co-morbidities of established treatments
• Cost-effectiveness
• Other causes of raised PSA

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8
Q

What are other causes of raised PSA?

A
  • Infection
  • Inflammation
  • Large prostate
  • Urinary retention
    (absence of raised PSA is not indication of absence of cancer)
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9
Q

Does an abnormal PSA indicate prostate cancer?

A

No, it can be raised in other diseases

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10
Q

Does a normal PSA rule uot cancer?

A

NO

• You can have a normal PSA but an abnormal feeling prostate on DRE (digital rectal examination)

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11
Q

How does prostate cancer present?

A
  • Urinary symptoms
  • Bone pain
  • Raised PSA, biopsy
  • Opportunistic finding from DRE
  • Incidental finding at transurethral resection of prostate
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12
Q

What is used for diagnosis of prostate cancer??

A
  • Distal rectal examination:
  • Ultrasound: used to define a prostatic mass
  • ↑PSA level in the blood: however, a normal result does not exclude the presence of cancer
  • Biopsy of the prostate: used to provide a histological diagnosis
  • Radiographs and bone scans: used to stage the tumour.
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13
Q

How will the prostate feel on DRE if prostate cancer?

A

hard and irregular prostate

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14
Q

What will be seen on radiographs and bone scans if there is metastasis?

A

Osteosclerotic lesions on radiographs and increased isotope uptake on bone scans are seen if there is metastatic spread.

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15
Q

How is prostate cancer staged?

A

Stage is determined by the TNM system:
• 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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16
Q

How is prostate cancer graded?

A

• The Gleason classification is used to grade the tumours on histological appearance. Grade 1 (well differentiated tumour composed of uniform tumour cells) to Grade 5 (anaplastic diffuse tumour with cells showing great variation in their structure and high mitotic rate).

17
Q

What may be seen in advanced prostate cancer?

A
  • Patients in advanced stages can develop sclerotic bone legions
  • ‘Hot spots’ on bone scan
18
Q

What is the treatment of prostate cancer dependent on?

A

• Before treatment is started a histological diagnosis of
prostatic carcinoma is required. Treatment depends
on the stage of tumour

19
Q

What are the treatment options for prostate cancer?

A

surgery, hormone therapy and radiotherapy

20
Q

What is the treatment for T1/T2 prostate cancer?

A

• T1/T2: radical surgical resection of the prostate
may be curative. TURP may be required
• Local radiotherapy can be used if the patient is
unfit for surgery, and to treat local or distant spread of the tumour
• Surveillance

21
Q

What is the treatment for advanced prostate cancer?

A
  • hormonal manipulation

* Palliative care

22
Q

What hormones are associated with increased prostate cancer growth?

A
  • Testosterone

* Dihydrotestosterone

23
Q

What is hormone treatment for prostate cancer?

A

Reduce levels of testosterone:

- surgical or chemical castration

24
Q

What is used for chemical castration and how does it work?

A

• GnRH agonists

  • constant LH instead of pulsatile
  • initially increase in LH and testosterone
  • HPG axis becomes exhuasted and there is reduction of LH and testosterone

• LHRH agonists

25
Q

What is given with initial GnRH/LHRH agonist and why?

A

Anti-androgen (bicalutamide)

  • prevent flare up of CaP due to initial increased testosterone
  • stops testosterone from reaching the cancer cells

Semester 3 - urinary (33 decks)

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