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Renal > 3.9: Prostate Cancer > Flashcards

3.9: Prostate Cancer Flashcards

1
Q

What is the prostate covered by?

*What kind of epithelium*

A

Transitional Epithelium

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2
Q

Where is the apex of the prostate?

Where is the base?

A

Apex = Inferior part that is continous with the striated sphincter

Base = Superior part, continious with bladder neck

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3
Q

Describe the zones of the prostate?

A

Transitional Zone - Surronds Urethra

Central Zone - Cone shaped region that surronds ejaculatory ducts

Peripheral Zone - Posterior/lateral part of prostate

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4
Q

What part of the prostate is most commonly affected in prostate adenocarcinoma?

A

Peripheral Zone

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5
Q

Is prostate cancer commmon or rare?

High or low mortality?

Do people die of prostate cancer or with prostate cancer?

A

Very Common

2nd Highest mortality from cancer

Has a long course and is slow growing - most people die with prostate cancer

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6
Q

Peak age range for prostate cancer?

What group is it rare in?

A

Elderly (>70)

Rare in anyone under 50

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7
Q

Who has a higher risk for prostate cancer:

  • Asians or Americans?
  • Caucasians or Blacks?
  • West or East?
A

Americans have a high risk, asians have a low risk

Blacks have a higher risk than caucasians

Prostate cancer common in west but not in east (Eg Common in America, Scandinavia but not Asia)

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8
Q

Prostate cancer is caused by mutations of what chromosomes/genes?

A

1q

8p

Xp

BRCA 2

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9
Q

Describe family history and risk of developing prostate cancer?

A

If you have one 1st degree relative, risk doubles

if you have two 1st degree relatives, risk quadruples

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10
Q

How are the majority of prostate cancers found? (What is the presentation)?

A

Most found due to PSA tests and abnormal DRE (Digital Rectal Exam)

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11
Q

Describe some of the symptoms of prostate cancer?

A

Urinary Symptoms - Nocturia, Frequency

Haematuria

Haematospermia

Bone pain

Weight Loss

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12
Q

75% of prostate cancers arise in the PERIPHERAL/CENTRAL zone?

A

75% of prostate cancers arise in the peripheral zone

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13
Q

Describe what you would feel on an abnormal digital rectal exam?

A

Asymmetrical

Nodule

Fixed Craggy Mass

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14
Q

True or false?

  • 50% of abnormal PR exams are associated with cancer of the prostate
A

True

50% of abnormal PR exams are associated with cancer of the prostate

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15
Q

True or False:

The majority of patients with prostate cancer who have an abnormal PR exam will have organ confined disease?

A

False

40% of patients who have an abnormal PR will have organ confined disease

This means 60% who have an abnormal PR will have metastatic disease

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16
Q

What is PSA?

Where is it produced?

A

Prostate Specific Antigen

Enzyme produced by the secretory epithelial cells of the prostate

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17
Q

Describe the serum and semen levels of PSA in a:

  • Healthy patient?
  • Patient with prostate cancer?
A

Healthy:

  • High SEMEN PSA
  • Low SERUM PSA

Cancer:

  • High SEMEN PSA
  • High SERUM PSA
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18
Q

Describe PSA sensitivity and specificity in prostate cancer?

A

Sensitivty = 90% (PSA is raised in 90% of cancers)

Specificity = 40% (Can be raised by many other causes so doesn’t definitly diagnose cancer)

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19
Q

Name some conditions that cause elevated PSA?

A
  • Benign Prostatic Hyperplasia
  • Prostatism/ UTI
  • Retention
  • Catherization
20
Q

Describe PSA testing in

  • Symptomatic Patients?
  • Asymptomatic Patients?
A

Symptomatic: Good test for prostate cancer, should be used

Asymptomatic: Can be used however must be counselled (Eg; May not be cancer, explain how it’s non-specific)

21
Q

Explain how you would counsell for PSA testing?

A

Must be done in asymptomatic patients

Very sensitive - 90%

Specific - 40%

Patient must be invovled in decision

If raised PSA is found, then you will have to do a biopsy and then treatment

May not be necessary or curative

22
Q

When would you carry out a trans-rectal ultrasound guided biopsy of the prostate?

A
  • Men with abnormal PR exam and raised PSA
  • Previous biopsy showing PIN or ASAP (pre-cancerous changes)
  • Normal biopsy but rising PSA
23
Q

Risks of rectal biopsy?

A

Sepsis

Rectal Bleeding

Haematuria and haematospermia for 3 weeks after

24
Q

The majority of prostate cancers are …?

A

Multifocal Adenocarcinomas

25
Q

Describe the bone lesions seen following prostatic metastases?

A

Sclerotic Lesions

26
Q

How are prostate cancers graded?

A

Gleason’s Scoring

Based on architectural appearance

27
Q

Apart from Gleason’s scoring, how else can prostate cancer be staged?

A

TNM Scoring

T = Tumour (Size/Invasion)

N = Nodes (Regional lymph nodes metastases)

M = Metastases

28
Q

What imaging is used to stage prostate cancer?

A

Bone Scans

MRI

CT Scan

29
Q

Give the TNM stage for:

  • Organ confined disease?
  • Locally advanced disease (not local lymph nodes)
  • Metastatic disease
A

Organ Confised: T1-2/N0/M0

Locally Advanced: T3/T4/N0/M0

Metastatic: T3/4/N1/M1

30
Q

Management of organ confined prostate cancer?

A

Watchful Waiting

Active Monitoring

Radical Surgery

Radical Radiotherapy

31
Q

Management of locally advanced disease?

A

Radiotherapy

Watchful Waiting

Hormonal Therapy

32
Q

Management of metastatic disease?

A

Androgen Deprivation Therapy

Steroids

Chemotherapy

33
Q

What hormone controls the prostate?

Where is this from?

A

Testosterone

From testis and adrenal gland

34
Q

Explain how androgen deprivation therapy works?

A

Starves the prostate cells from androgens (Testosterone)

This causes apoptosis

Helps treat symptoms

35
Q

What is used for hormone therapy in prostate cancer?

How do they work?

A

LRHR Agonists (luteinizing-hormone releasing hormone agonists)

Long term use causes down-regulation of LRHR receptors and then suppression of pituitary LH and FSH leading to drop in testerone

36
Q

Describe the flare up of LRHR agonists?

How do you prevent this?

A

When they are first given, they cause increased LRHR receptors, increased LH and FSH and increased testerone

In 20% of patients, this causes catastrophic spinal cord compression

Anti-Androgen is given 1 week before and 2 weeks after the LHRH agonist injection

37
Q

Side effects of LHRH agonists?

A

Loss of libido

Erectile Dysfunction

Hot flushes and sweats

Weight Gain

Gynaecomastia

Anaemia

Cognitive Changes

Osteoporosis

38
Q

Describe how anti-androgens work?

A

Compete with testoerone and DHT for binding sites

This promotes apoptosis and inhibits prostate cancer growth

39
Q

Describe the two types of anti-androgens and their side effects?

A

Steroid (Eg: Cyproterone Acetate)

  • Loss of libido, erectile dysfunction, gynaecomastia, cardiovascular toxicity and hepatotoxicity

Non-Steroidal (Nilutamide, Flutamide, Bicalutamide)

Sexual interest and libido maintained

Gynaecomastia, hot flushes, breast pain, sweating, hepatotoxicity

40
Q

What are the types of transitional cell cancer?

A

Papillary (80%)

Non Papillary (20%)

41
Q

Risk factors for bladder cancer?

A

Chemical exposure (Factory workers, hairdressers, etc.)

Smoking

42
Q

Symptoms of bladder cancer?

A

Painless Haematuria *MOST COMMON SYMPTOM

Also increased frequency

Urge

Dysuria

43
Q

Imaging in bladder cancer?

A

Cystoscopy

CT
MRI

44
Q

Is urinary bladder cancer more common in:

  • Males or females?
  • Elderly or young?
A

More common in males

More common after 5th decade of life

45
Q

What two epithelium of the bladder can cancer occur in?

A

Transitional (Most common)

Squamous

Renal (34 decks)

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