Cancer - Prostate Flashcards
Where are most prostate cancers found?
Peripheral zone
What are the stages of prostate cancer?
Localized
Locally Advanced
Metastatic
Hormone Refractory (i.e. resistant to castration)
Risk factors for Prostate Cancer?
Age
African/Afro-Caribbean
Family History
High fat/processed carb diet
Drugs like Finasteride can actually REDUCE risk but increase risk of developing higher grade prostate cancer
How might a prostate cancer present?
Most present with non cancer-specific symptoms, just LUTS & UTIs
What symptoms would indicate an invasive prostate cancer?
- Loin/perineal/suprapubic pain
- Impotence
- Haematuria or haemospermia
- Renal Failure
- Rectal Symptoms
What symptoms would indicate a metastatic prostate cancer?
- Bone Pain or sciatica
- Spinal cord compression (Paraplegia)
- Lymph Node Enlargement
- Lymphoedema
- Loin pain/anuria (lymph nodes obstruct ureters)
- Lethargy due to anaemia or uraemia
- Weight loss & Cachexia
What is Cachexia?
Weakness and wasting of the body due to severe chronic illness.
65 yr old man presents with frequency, dysuria and slow to start urination. How would you confirm its prostate cancer?
Prostate/Rectal Exam - a hard, craggy prostate will be felt
TRUS-guided biopsy (Transrectal ultrasound)
What investigations do we do to stage prostate cancer?
Prostate Specific Antigen (PSA)
TRUS guided biopsy
CT pelvis, chest/abdo
MRI pelvis
What can cause an elevated PSA?
The upper limit increases with age.
Prostate cancer! But also:
- UTI
- Chronic prostatits
- Instruments e.g. catheter
- Physiological e.g. ejaculation
- Recent urological procedure
- BPH (not a cancer)
How is Prostate Cancer Treated? What are the different combinations?
Hormone Therapy:
- Alone
- Intermittent
- Followed by Surgery
- Followed by radiotherapy
Types of radiotherapy for prostate cancer?
External beam RT
Brachytherapy - radioactive material is inserted directly into the site
Major types of hormone therapy?
Surgical castration (Bilateral Orchidectomy)
Chemical Castration with LHRH analogue
Anti-androgens
Oestrogens
How does chemical castration work?
LHRH analogue (e.g. goserelin) downregulates androgen receptors by -ve feedback.
It causes the tumour to flare in the first week of therapy so you need combined anti-androgens
How do anti-androgens work?
Inhibit androgen receptors on the prostate
