cancer- prostate Flashcards
1
Q
what is prostate cancer
A
- Walnut sized gland in the male pelvis
- Located inferior to the bladder and anterior to the rectum
- Cancer occurs when there is uncontrolled growth of glandular cells in the prostate
- 99% of all prostate cancers are adenocarcinomas
- Rarely can be sarcomas, TCC, SCC and neuroendocrine
- Often slow growing but can be more aggressive
- Most commonly found in the posterior peripheral portion (70%)
- Not to be confused with benign prostatic hyperplasia
2
Q
aetiology of prostate cancer
A
- No known exact cause
- Family history of prostate, breast and ovarian cancer
- Race: higher in African decent lower in Asian
- High levels of testosterone
- Some links with genetic mutations
- High red meat or fatty food consumption
- Overweight or obese men have increased incidence of aggressive prostate cancer
- Possible links to smoking, chemical exposure, prostatitis, STI’s and vasectomy
3
Q
epidemiology of prostate cancer
A
- 19000 new cases diagnosed every year
- 25% of total cancers diagnosed in males
- 2nd most prevalent cancer overall
- 3300 deaths per year (3rd most common cancer cause)
- 12% of all male deaths from cancer
- 5 year survival rate approx. 95%
- Risk of developing prostate increases with age
- Most prostate cancers develop after the age of 50
- Less prevalent in indigenous population but higher mortality
4
Q
signs and symptoms of prostate cancer
A
- Usually shows no symptoms until cancer is large enough to put pressure on urethra
- Frequent or sudden need to urinate
- Difficult to urinate (for example, trouble starting or not being able to urinate when the feeling is there or poor urine flow)
- Discomfort when urinating
- Blood in urine or semen
- Pain in the lower back, upper thighs or hips
- Many diseases can cause these symptoms
5
Q
what is the importance of diagnostic testing for prostate cancer
A
- Early detection is important for successful outcome
- Screening tests valuable in early detection
- Physical examination and medical history
- Rectal examination feeling for hard and bumpy gland
- Referred to as digital rectal exam (DRE)
- Blood test to check for prostate-specific antigen (PSA), a protein produced by the prostate
- The level of PSA can be higher than normal in people with prostate cancer (but also in people with other prostate conditions that are not cancer)
- Biopsy
- Medical Imaging tests
6
Q
what medical imaging tests are utilised for prostate cancer
A
CT
MRI
US
NM
7
Q
why is MRI utilised for imaging prostate cancer
A
- Increasing role in the confirmation of diagnosis
- Important modality in the staging of prostate cancer
- Increased contrast resolution allows for more accurate evaluation of localised spread and define boarders of the tumour
- Helps guide area for tumour biopsy
- Allows visualisation of extension into nearby tissues
- Identify spread to local lymph nodes
- Used in planning of radiation therapy
- Potentially helpful in identification of liver metastases
- Used in the evaluation of tumour recurrence
- Alternative modality to U/S for biopsy guidance
8
Q
why is US utilised for imaging prostate cancer
A
- Transrectal Ultrasound (TRUS) is often initially performed to detect abnormalities and to guide biopsy
- Usually next step following an abnormal PSA level or DRE
- Conventional ultrasound often used as a screening test to rule out other causes for raised PSA. (e.g. Benign prostatic hyperplasia)
- Potential use in evaluation biopsy of metastases (e.g. liver)
- TRUS preferred modality for placement of Brachytherapy seeds treatment therapy
9
Q
Why is CT utilised in imaging prostate cancer
A
- Standard CT Abdomen is insensitive to Prostate Cancer detection
- Has the ability to identify other complicating abdominal pathologies
- Commonly used in the staging of Prostate Cancer
- Sensitive test to common sites of metastatic spread. (bone, lung & liver)
- Used to check placement of brachytherapy seeds
10
Q
why is NM utilised when imaging prostate cancer
A
- Technetium bone scans preferred method of identifying bone mets
- Prostate cancer most commonly metastasises to bone
- Gallium Prostate Specific Membrane Antigen (PSMA) PET scans highly sensitive in the detection of prostate cancer cells
- Used in the diagnosis, staging, restaging, recurrence, therapy response and patient prognosis
- Fluorine-18-fluciclovine PET is used to detect and localise suspected prostate cancer recurrence based on elevated prostate-specific antigen in men who have undergone prior treatment
11
Q
prostate cancer staging
A
- GP, then urologist and then digital examination
- Ascertain tumour size, location and spread
- Know extent of disease to plan the best treatment plan
- TMN system
12
Q
what is the T score
A
- Describes growth of primary tumour
- Prostate cancer uses both a clinical and pathological T score
- Clinical T Score
- T0: There is no evidence of primary tumour
- T1: Clinically inapparent tumour that is not palpable
- T2: Tumour is palpable but confined within the prostate
- T3: Extraprostatic tumour that is not fixed or does not invade adjacent structures
- T4: Tumour is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall
- Pathological T Score
- T2: Organ confined
- T3: Extraprostatic extension
- T4: Tumour is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall
13
Q
what is the N score
A
- The ‘N’ in the TNM system stands for lymph nodes
- Regional lymph node status
- Lymph nodes of the pelvis, inferior to iliac bifurcation
- NX: regional nodes were not assessed
- N0: no positive regional nodes
- N1: metastases in regional node(s)
- Regional node status is usually assessed via diagnostic imaging and biopsy
14
Q
what is the M score
A
- The ‘M’ in the TNM system describes cancer that has spread to other parts of the body
- Common sites of spread for Prostate cancer Bone, Liver and lungs
- M0: The disease has not spread to a distant part of the body
- M1a: The cancer has spread to non-regional lymph nodes
- M1b: The cancer has spread to the bone
- M1c: The cancer has spread to other distant sites without bone involvement. (Lung, Liver, etc.
15
Q
what is the gleason score
A
- Histological examination of biopsied tumour
- Used to assess the aggressiveness of the tumour
- Samples of the two largest areas of tumour are taken
- Gleason Score ranges from 1-5 and describes how much the cancer from a biopsy looks like healthy tissue
- Higher the score the more abnormal the tissue
- Most cancers have a score of 3 or more
- Scores of 6 or less grow slowly and have good prognosis
- 7 is an intermediate risk of aggressive cancer
- 8-10 are high grade cancers that are likely to spread rapidly
