[4] Prostate Cancer Flashcards by Elliot Jones

How common is prostate cancer, compared to other cancers?

Most common male cancer

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How deadly is prostate cancer, compared to other cancers?

3rd most common cause of male cancer death

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What % of men over 80 have prostate cancer?

80%

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What ethnicity has the highest prevalence of prostate cancer?

Black people

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What kind of cancer is prostate cancer?

Adenocarcinoma

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Where does prostate cancer affect?

The peripheral zone of the prostate

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Is prostate cancer always symptomatic?

No, it is usually asymptomatic

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What are the urinary symptoms of prostate cancer?

Nocturia
Frequency
Hesitancy
Poor stream 
Terminal dripping
Obstruction

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What are the systemic symptoms of prostate cancer?

Weight loss

Fatigue

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What are the metastatic symptoms of prostate cancer?

Bone pain

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What is found on DRE in prostate cancer?

Hard, irregular prostate on PR

Loss of midline sulcus

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Where does prostate cancer spread locally?

Seminal vesicles
Bladder
Rectum

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Which lymph nodes does prostate cancer spread to?

Para-aortic nodes

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What does prostate cancer cause if it spreads haematologically?

Sclerotic bony lesions

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What bloods are done in prostate cancer?

PSA
U&E
Acid and alk phos
Calcium

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What imaging is done in prostate cancer?

XR chest and spine
Transrectal US and biopsy
Bone scan
Staging MRI

How can the detection of affected nodes be improved in MRI staging scan for prostate cancer?

Contrast enhancing magnetic nanoparticles

What is PSA?

A proteolytic enzyme used in liquefaction of ejaculate

What can cause an increase is PSA?

Prostate cancer
Age
PR
TURP
Prostatitis

What % of small cancers have a normal PSA result?

30%

How is Gleason grade calculated?

Score the two worst affected areas

How is Gleason trade interpreted?

The sum is inversely proportional to prognosis

What is the importance of prognostic factors in prostate cancer?

Help determine whether to pursue radical Rx

What are the prognostic factors in prostate cancer?

Age
Pre-Rx PSA
Tumour stage
Tumour grade

What is the problem with the management fo prostate cancer?

It is difficult to know which tumours are indolent and will not cause mortality before something else, and radical therapy is assocaited with significant mortality

What is involved in the conservative management of prostate cancer?

Close monitoring with DRE and PSA

What are the options in the radical therapy of prostate cancer?

Radical prostatectomy | Brachytherapy

What is used alongside radical prostatectomy if the cancer is node +ve?

Goserelin

How is a radical prostatectomy performed?

Laparoscopically with a robot

What is the limitation of the survival increase with radical prostatectomy for prostate cancer?

It only improves survival vs active monitoring if <75 years

What happens in brachytherapy for prostate cancer?

Implantation of palladium seeds

What are the side effects of radical therapy for prostate cancer?

Erectile dysfunction Urinary incontinence Death

Where is medical therapy for prostate cancer used?

Metastatic or node +ve disease

What is involved in the medical therapy of prostate cancer?

LHRH analogues | Anti-androgens

Give an example of an LHRH analogue?

Goserelin

How do LHRH analogues work in prostate cancer?

They inhibit pituitary gonadotrophins, decreasing testosterone

Give two examples of anti-androgens

Cyproterone acetate | Flutamide

What can be used in the symptomatic management of prostate cancer?

TURP for obstruction Analgesia Radiotherapy for bone mets/cord compression

Why is population based screening for prostate cancer using PSA not recommended in UK?

PSA not accurate tumour marker Trials show small or no mortality benefit Must balance mortality benefit with harm caused by over-diagnosis and over treatment of indolent cancers