Cancer of the Prostate Flashcards
What is the prevalence of prostate CA?
1/7 men
1/6 diagnosed die
What are RFs for prostate CA?
- Strong family hx (#1)
- Environmental
- Dietary
- High serum testosterone
Prostate CA responds to…
hormonal deprivation
Men castrated before puberty…
do not develop prostate CA
What are signs & sx of prostate CA?
- Early: none
- Late: obstructive sx
- Later: metastatic sx
What are the general principles of the digital rectal exam?
- Hard nodules –> biopsy
- Questionable nodules –> PSA
What is the purpose of the DRE?
- Check prostate
- Check for blood in stool
- Detect rectal CA
What is prostate specific antigen? (PSA)
Serine protease
What produces PSA? Where is it secreted?
- Produced by epithelial cells lining acini & ducts of prostate gland
- Secreted in seminal fluid, very little should enter circulation
- Liquefaction of seminal coagulum
Where is PSA found?
- Normal prostatic tissue
- BPH tissue
- Primary & metastatic prostate CA
What benign conditions can cause elevation of PSA?
- Acute urinary retention
- BPH
- Prostatitis
- Prostatic infection
- Prostatic intraepithelial neoplasia (PIN)
- Instrumentation or catherization
What is PSA velocity? What may it detect?
- Change in PSA over a period of time
- May detect early prostate CA before other methods
What is PSA density?
Serum PSA divided by prostate volume
- >.15 may be significant
PSA density is helpful in…
differentiating prostate CA from BPH
What are 2 categories of genomic testing?
- PCA 3
- 4K Score
What imaging test is used to dx prostatic CA?
MRI
- Multiparametric
- PI-RADS score
- Targeted fusion biopsy
Transrectal ultrasonography/biopsy
What are sx of metastasis?
- Bone pain
- Wt loss
- Anemia
- Azotemia
- Fatigue
- Dyspnea
- Lymphedema
- Ureteral obstruction
What imaging tests do you use to evaluate metastatic prostate CA?
- Nuclear medicine bone scan
- CT abd & pelvis
- PET
What are tx options for prostate CA?
- Surgery (radical prostatectomy)
- Radiation (external beam, seed implantation)
- Hormonal manipulation
- Observation/surveillance
What are 3 complications of radical prostatectomy?
- Impotence
- Bladder neck contractures
- Incontinence
Describe: hormonal manipulation
- Objective tumor regression measurable by bone scan, CT, & PSA
- Bilateral orchiectomy
- LH-RH Analogs
- Antiandrogens
What are 2 examples of LH-RH Analogs?
- Leuprolide
- Goserelin
What are side effects of LH-RH Analogs?
- N/V/D
- Peripheral edema
- Gyencomastia
- Hot flashes
