[4] Prostate Cancer Flashcards
How common is prostate cancer, compared to other cancers?
Most common male cancer
How deadly is prostate cancer, compared to other cancers?
3rd most common cause of male cancer death
What % of men over 80 have prostate cancer?
80%
What ethnicity has the highest prevalence of prostate cancer?
Black people
What kind of cancer is prostate cancer?
Adenocarcinoma
Where does prostate cancer affect?
The peripheral zone of the prostate
Is prostate cancer always symptomatic?
No, it is usually asymptomatic
What are the urinary symptoms of prostate cancer?
Nocturia Frequency Hesitancy Poor stream Terminal dripping Obstruction
What are the systemic symptoms of prostate cancer?
Weight loss
Fatigue
What are the metastatic symptoms of prostate cancer?
Bone pain
What is found on DRE in prostate cancer?
Hard, irregular prostate on PR
Loss of midline sulcus
Where does prostate cancer spread locally?
Seminal vesicles
Bladder
Rectum
Which lymph nodes does prostate cancer spread to?
Para-aortic nodes
What does prostate cancer cause if it spreads haematologically?
Sclerotic bony lesions
What bloods are done in prostate cancer?
PSA
U&E
Acid and alk phos
Calcium
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
