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4th Year CCC > Prostate cancer > Flashcards

Prostate cancer Flashcards

1
Q

Function of the prostate

A

Makes seminal fluid that is stored in the seminal vesicles

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2
Q

Linked to what cancer in mother/sister?

A

Breast (BRCA link)

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3
Q

Who can request a PSA?

A

Men >50

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4
Q

5 signs of metastatic disease?

A

Anaemia

Lymphoedema

Malaise

Bone pain

Wt loss

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5
Q

What investigation is done at urology?

A

MRI guided transrectal biopsy

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6
Q

Risk with transrectal biopsy?

A

Bacteriaemia and death

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7
Q

Grading score used

A

Gleason score

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8
Q

How does gleason score work?

A

Look at biopsies

The cells present could be graded 1-5

1 and 2 ignored

The two most common tissue types are taken and used as two numbers to give the score.

e.g. if all were 3 then 3+3=6. If mostly 4, some 3 and a few 5 then 4+3=7

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9
Q

What are the best and worst gleason scores? How are they categorised?

A

6 lowest, 10 highest

6=low risk

7= intermediate risk

8-10 = aggressive

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10
Q

How is prostate cancer staged?

A

TNM

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11
Q

What is T1-4 in staging?

A

T1- biopsy only

T2- in prostate

T3- breaching capsule

T4- into rectum/bladder

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12
Q

How is overall risk done?

A

Combine gleason score, T (of TNM) and PSA

Low/int/high risk

Low risk- gleason <6, T 1c/2a, PSA <10

Intermediate risk- gleason 7, T2b/c, PSA 10-20

High risk- gleason >/=8, PSA>/=20

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13
Q

What is TX

A

The primary tumour cannot be evaluated.

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14
Q

At what stage would a tumour be felt on PR?

A

> T2

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15
Q

At what stage would a tumour be felt on PR?

A

> T2

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16
Q

What makes the cancer >/= T2b?

A

Involves more than half of 1 side of the prostate

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17
Q

Management options (local)

A

Robotic laparoscopic prostatectomy

RT

Brachytherapy

Active monitoring

Watchful waiting

18
Q

Drawbacks of prostatectomy?

A

Risk impotence and incontinence

Infertile afterwards but can store sperm

19
Q

How likely is it that a man might get impotence after prostatectomy?

A

Before having any treatment, 67% of men said they could get erections firm enough for intercourse. When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.

20
Q

How likely is it that a man might get urinary incontinence after prostatectomy?

A

1% of men said they used absorbent pads before having any treatment. When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.

21
Q

How likely is prostatectomy to cure the cancer?

A

For around 1 in 3 men, the cancer cells may not be fully removed and may return some time after the operation.

22
Q

what must men do to prepare for their RT treatment each time?

A

Enema first and have a full bladder to minimise bladder and bowel damage and ensure prostate in same position.

Only actually takes 2-3 mins

23
Q

Who is RT good for?

A

Older/co-morbs

24
Q

what is the risk with RT

A

LT bowel probs

25
Q

Who is brachytherapy good for

A

Fit, no-comorbs

26
Q

Who should avoid brachytherapy?

A

Large prostate/significant urinary sx

27
Q

How is brachytherapy done

A

US probe in rectum

GA 4 hours

Through perineum deliver radiation ± insert radioactive seeds

28
Q

SE brachytherapy?

A

Significant urinary SEs (temporary)

29
Q

Temporary SEs RT?

A

Diarrhoea

Soreness in the area

Loss of pubic hair

Tired

Cystitis

30
Q

RT impotence stats?

A

67% of men said they could get erections firm enough for intercourse, decreasing to 22% after 6 months. Although this improved over the next 6 months, when asked again after 6 years, it had declined again to 27%.

31
Q

RT likelihood of it returning?

A

1/3 same as prostatectomy

32
Q

How do the brachytherapy SEs compare with RT?

A

the risk of urinary problems is higher

the risk of sexual dysfunction is the same.

The risk of bowel problems is slightly lower.

33
Q

What is involved with active monitoring?

A

MRI annually, if change then biopsy ± ?treat, if not continue to monitor

34
Q

What is watchful waiting and who gets it

A

Older men with co-morbs who you think will die of something else

No radical treatment

Maybe sx control

35
Q

Advanced treatment options?

A

Androgen deprivation therapy -

  1. antiandrogen therapy,
  2. chemical castration,
  3. orchidectomy

Other systemic drugs (chemo or other)

Pallative RT for bone pain

36
Q

What does anti androgen therapy do?

A

Prevents testosterone binding to receptors

e.g. flutamide

37
Q

What is chemical castration

A

GnRH analogue- inhibits formation of LH in pituitary e.g. leuprorelin

38
Q

SEs anti androgens

A

Hot flushes

Decrease sexual function/shrink genitals

Decreased muscle bulk and strength

Memory or mood disturbance

10% wt gain (central) –> risk DM

Osteoporosis and fracture risk

?CV risk

39
Q

Where is prostate ca likely to spread?

A

Lymph and bones

40
Q

Histological type of prostate ca?

A

Adenocarcinoma

4th Year CCC (19 decks)

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