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Surgery: Upper GI > Adenocarcinoma Of The Prostate > Flashcards

Adenocarcinoma Of The Prostate Flashcards

1
Q

How many new diagnoses of PA each year in the uk?

A

30,000

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2
Q

How many men die from PA each year in the UK?

A

10,000

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3
Q

PA shows its peak incidence in which decade of life?

A

8th

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4
Q

What percentage of cases present with metastatic disease?

A

20%

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5
Q

What proportion of men present with PA in its early stage?

A

40%

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6
Q

What are the normal presenting symptoms? (7)

A

LUTS:
Voiding: 1 poor urine flow 2 post-micturition dribbling 3 hesitancy
Storage: 4 urgency 5 nocturia 6 frequency 7 urge incontinence

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7
Q

What do bone pain, pathological fractures and signs of hypercalcaemia on presentation suggest?

A

Metastatic disease

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8
Q

What signs on DRE suggest malignant change?

A

Areas of firmness and palpable nodules

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9
Q

Advantage of serum PSA as a screening tool?

A

High sensitivity

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10
Q

Disadvantage of serum PSA as a screening tool?

A

Low specificity

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11
Q

How is PSA used to investigate ?prostate adenocarcinoma? (2)

A

1 Elevated levels used in decision to biopsy 2 according to age-specific serum levels

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12
Q

How is TRUS performed? (4)

A

1 rectal ultrasound probe inserted 2 ultrasound used to locate areas in prostate for biopsy 3 biopsy needle inserted through perineum into prostate to take samples 4 ABx given prophylactically due to high risk of infection

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13
Q

What is the Gleason Score used for?

A

Grading PA

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14
Q

What does a Gleason Score of 1+1=2 indicate? (rare)

A

Very well differentiated non-cancerous tissue

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15
Q

What does a Gleason Score of 5+5=10 indicate? (2)

A

1 very poorly differentiated tissue 2 cancer likely to spread rapidly

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16
Q

How is extracapsular extension and pelvic lymph node spread investigated?

A

Pelvic MRI

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17
Q

When might laparoscopic node biopsy be used?

A

To sample enlarged nodes if considering radical treatment

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18
Q

How are bone metastases detected?

A

Isotope bone scans

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19
Q

In those with localised disease and LE <10y, what is the usual treatment plan?

A

Watchful waiting until rising serum PSA detected

20
Q

What does rising serum PSA indicate?

A

Active disease progression

21
Q

How are LUTS treated? (2)

A

1 Hormone therapy (finasteride) or 2 alpha blocker (Tamsulosin)

22
Q

Which androgen antagonist is used in this Trust?

A

Finasteride 5mg

23
Q

Which alpha blocker is used in this trust?

A

Tamsulosin 400micrograms

24
Q

Treatment for severe symptoms with features of obstruction?

A

TURP considered

25
Q

What are the features of obstruction?

A

FILL IN LATER

26
Q

Treatment plan when disease localised but LE >10y? (2)

A

1 Radical treatment 2 aimed at cure

27
Q

Options for curative treatment?

A

1 radical prostatectomy 2 external beam radiotherapy 3 brachytherapy

28
Q

Complications of radical prostatectomy?

A

1 severe incontinence 3% 2 ED 45%

29
Q

What dose, and how many fractions, of radiotherapy in radical treatment? (1)

A

1 55-70Gy 2 20-25 fractions

30
Q

Common complications of external beam radiotherapy? (3)

A

1 cystitis 2 proctitis 3 ED

31
Q

What is brachytherapy?

A

Radioactive seeds implanted by TRUS guidance

32
Q

Problems with TRUS guidance?

A

New technique so long-term follow up data inconclusive

33
Q

Is locally advanced PA curable?

34
Q

Treatment regime of LHRH agonists?

A

3-monthly depot injections

35
Q

Mechanism of action for LHRH agonists? (2)

A

1 Suppress testosterone production at testes 2 less androgenic drive in PA cells

36
Q

Side effects of LHRH agonists? (3)

A

1 Hot flushes 2 lethargy 3 loss of sexual function

37
Q

Mechanism of action for anti-androgens?

A

Competitive inhibition at androgen receptor

38
Q

Advantage of anti-androgens over LHRH agonists for the patient?

A

1 serum testosterone levels do not drop 2 so sexual function may be preserved

39
Q

Complications of anti-androgen therapy? (2)

A

1 gynaecomastia 2 nipple tenderness

40
Q

Treatment plan for metastatic disease?

A

1 LHRH analogues +/- anti-androgen 2 radiotherapy in cases of bone pain

41
Q

Does hormone therapy remain highly efficacious? (2)

A

1 No 2 all PA becomes hormone resistant

42
Q

When is chemo appropriate? (2)

A

1 patients with good performance status 2 with hormone-resistant disease

43
Q

How is radiotherapy used in metastatic disease?

A

Helps with bone pain (in conjunction with bisphosphonates)

44
Q

10y survival for localised PA?

45
Q

Survival time in locally advanced disease?

A

7y (median)

46
Q

Prognosis for metastatic disease?

A

2-3y survival

47
Q

How prognosis changes once PA is hormone-resistant?

A

6-12month survival

Surgery: Upper GI (3 decks)

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