Bladder and Prostate Cancer Flashcards
what are the 3 zones of the prostate
transitional zone
- gives rise to BPH
central zone
peripheral zone
- origin of up to 70% of prostate adenocarcinoma
clinical presentation of prostate cancer
- gross majority asymptomatic
- lower urinary tract symptoms e.g. hesitancy, nocturia, poor stream
- hematuria/hematospermia
- bone pain, anorexia, weight loss
how is asymptomatic prostate cancer picked up
PSA tests
Abnormal Rectal exam
- asymmetry, nodule, fixed craggy mass
why is PSA not very specific for diagnosing prostate cancer
can be elevated by other reasons
- BPH
- prostatitis/UTIs
- retention
- cathererisation
- DRE
Ix for prostate cancer
Trans-rectal USS guided prostate biopsy
when is Trans-rectal USS indicated
men with an abnormal DRE, an elevated PSA
Previous biopsies showing PIN or ASAP
Previous normal biopsies but rising PSA trends
what are the majority of prostate cancers
multifocal adenocarcinomas
where are the most common sites for mets of prostate cancer and why are they unique
pelvic lymph nodes and the skeleton
are Sclerotic lesions i.e. form bones
what is used as a way to predict prognosis
Gleason’s score
what is used to stage cancers
TNM
T - primary tumour
N - regional lymph nodes
M - distant mets
what are the classifications of prostate cancer
Organ-Confined disease
T1-2 N0 M0
Locally advanced Disease
T3-4 N0 M0
Metastatic Disease
N+, M+
Mx of organ confined disease
Watchful waiting
Surgery
- Radical prostatectomy
Radical Radiotherapy
possible complications of radical prostatectomy
erectile dysfunction
incontinence
bladder neck stenosis
possible complications of radial radiotherapy
Irritative lower urinary tract symptoms Hematuria GI symptoms Erectile dysfunction Incontinence
Mx of locally advanced disease
radiotherapy with neo-adjucant hormonal therapy
hormonal therapy
Mx of metastatic disease
Androgen Deprivation Therapy
- Hormonal therapy (Anti-Androgens, Anti-LNRH)
- Bilareal subcapsular orchidectomy
- maximal androgen blockade
Diethylstilbesterol/steroids
Cytotoxic chemotherapy
what is the growth of prostate cancer cells under the influence of
testosterone
dihydrotestosterone
how can apoptosis in prostate cancer cells be stimulated
deprived of androgenic stimulation
what happens after chronic exposure to LNRH agonists as part of hormonal therapy
down-regulation of LHRH-receptors, with subsequent suppression of pituitary LH and FSH secretion and testosterone production
side effects of LNRH agonists
Loss of libido,ED Hot flushes and sweats Weight gain Gynaecomastia Anaemia Cognitive changes, Osteoporosis
why is an anti-androgen given 1-2 weeks before an LNRH agonists is started
LHRH analogues initially stimulate pituitary LHRH receptors, inducing a transient rise in LH and FSH release, and consequently elevate testosterone production
how do anti-androgens work
compete with testosterone and DHT binding on receptor in the prostate cell nucleus
promote apoptosis and inhibit cancer growth
examples of anti-androgens
steroidal - cyproterone acetate
non-steroidal - nilutamide, flutamide
side effects of steroidal anti-androgens
loss of libido and erectile dysfunction
gynaecomastia
cardiovascular toxicity hepatotoxicity
