Carcinoma of prostate

Question 1

RFx CaP?

Answer 1

• African descent
• high dietary fat = 2x risk
• FHx: 1st degree = 2x

Question 2

Epidemiology of CaP?

Answer 2

• Most prevalent cancer in males; 3rd cause male Ca deaths

- up to 50% risk CaP at 50y

Question 3

Most common pathological type of CaP?

Answer 3

-Adenocarcinoma >95%; often multifocal

Question 4

Second most common pathological type of CaP?

Answer 4

• Urothelial carcinoma (4.5%)

- ass/w TCC of bladder

Question 5

CFx of locally advanced CaP?

Answer 5

• Storage and voiding LUTS

- ED

Question 6

How is CaP most commonly detected?

Answer 6

• DRE
• Elevated PSA
• Incidental finding on TURP

Question 7

DRE findings of CaP?

Answer 7

Hard, irregular nodule or diffuse dense induration involving one or both lobes

Question 8

Patten of CaP mets?

Answer 8

• Mets to axial skeleton common
• Visceral mets less common (liver, lung and adrenal gland)
• Leg pain and oedema with nodal mets obstructing lymphatic and venous drainage

Question 9

Methods of CaP spread?

Answer 9

• Local invasion
• Lymphatic spread to regional LNs (obturator, iliac, pre sacral / para-aortic)
• haematogenous dissemination occurs early

Question 10

Ix if CaP workup?

Answer 10

• DRE
• PSA elevated
• TRUS guided needle Bx
• Bone scan may be omitted in untreated CaP with PSA

Question 11

How is prostate cancer staged?

Answer 11

TNM (adenocarcinoma only)

Question 12

Determination of T in TNM staging? (broad categories)

Answer 12

T1: clinically undetectable tumour, normal DRE and TRUS
T2: palpable, confined to prostate
T3: tumour extends through prostate capsule
T4: tumour invades adjacent structures (besides seminal vesicles)

Question 13

what is firmagon?

Answer 13

Degarelix: 3rd generation GnRH blocker.

-Forms depot follow S/C injection

Question 14

How does degarelix work?

Answer 14

GnRH blocker: competitively and reversibly binds to GnRH receptors thereby reducing release of gonadotropins and therefore testosterone

Question 15

What is the rationale for degarelix in CaP Rx?

Answer 15

• CaP sensitive to testosterone deprivation, therefore a mainstay of treatment
• Does not induce LH surge with subsequent testosterone/tumour stimulation (cf GnRH agonists)

Question 16

Degarelix precautions?

Answer 16

• May prolong QT interval (to same extent as leuprorelin)
• Decreased bone density
• Antibody formatin (not clinically significant)
• Some LFT disturbance

Question 17

AEx degarelix?

Answer 17

Mostly physiological 2" dec testosterone:
-Hot flushes 
-Weight increase
Or site reaction:
-erythema
-pain
-nodule

Question 18

what is leuprorelin?

Answer 18

GnRH analog used in the treatment of:

• hormone responsive cancers (prostate, breast)
• precocious puberty
• oestrogen dependent conditions (endometriosis, fibroids)

Question 19

Leuprorelin MoA?

Answer 19

Pituitary GnRH receptor agonist

• interrupts normal pulsatile stimulation of, thus desensitising GnRH receptors
• indirectly down regulates secretion of LH and FSH
• thus decreases estradiol and testosterone (in M & F)