Carcinoma Of The Prostate Flashcards
What is the most common type of prostate cancer?
Adenocarcinoma (>95% of cases).
Which hormone influences the development of prostate cancer?
Testosterone and dihydrotestosterone.
What is the Gleason grading system based on?
Glandular differentiation; graded from 1 to 5.
What are the main risk factors for prostate cancer?
Age, family history, genetic mutations, smoking, alcohol intake.
Which genetic mutations are associated with hereditary prostate cancer?
BRCA2, HPC1 (1q), MSR1 (8p), XP, and Y chromosome mutations.
Which zone of the prostate is most commonly affected by cancer?
Peripheral zone (75% of cases).
How does prostate cancer typically spread locally?
Through the prostatic capsule, seminal vesicles, bladder, and urethral sphincter.
What is the most common site of distant metastasis in prostate cancer?
Bones, particularly the axial skeleton (spine, pelvis, ribs).
What type of bone metastases is more common in prostate cancer?
Sclerotic (85%) rather than lytic (15%).
What venous system allows direct spread of prostate cancer to the spine?
Valveless prevertebral veins connecting the prostatic venous plexus to vertebral veins.
What is the most common clinical presentation of localized prostate cancer?
Asymptomatic; may be detected by elevated PSA or abnormal DRE.
What urinary symptoms may indicate prostate cancer?
Hematuria, voiding discomfort, hematospermia, lower urinary tract symptoms.
What symptoms suggest locally advanced prostate cancer?
Urinary obstruction, renal failure, malignant priapism, rectal obstruction.
What symptoms suggest metastatic prostate cancer?
Bone pain, anemia, jaundice, coagulopathy, weight loss, lower limb swelling.
What percentage of prostate cancers are organ-confined at diagnosis?
Only 40% of cases detected by DRE are organ-confined.
What is the primary role of Prostate-Specific Antigen (PSA)?
Liquefies ejaculate; produced by prostate epithelial cells.
What are the main forms of PSA in circulation?
Complexed/bound PSA (75%) and free PSA (25%).
What is a significant PSA threshold for predicting prostate cancer?
PSA > 50 ng/ml is associated with lymph node involvement in 75% of cases.
Name three benign conditions that can elevate PSA.
BPH, prostatitis, urethral instrumentation.
What drugs can artificially lower PSA levels?
5-alpha reductase inhibitors, anti-androgens, GnRH agonists.
What imaging modality is used for prostate cancer staging?
Multiparametric MRI.
What is the role of a radionucleotide bone scan in prostate cancer?
Detects bone metastases.
What are complications of advanced prostate cancer?
Anemia, spinal cord compression, visceral metastases, renal failure, coagulopathy.
What are the main management options for localized prostate cancer?
Watchful waiting, active surveillance, radical prostatectomy, EBRT, brachytherapy.
What surgical technique is used for radical prostatectomy?
Open, laparoscopic, or robotic-assisted radical prostatectomy.
What is the primary treatment for locally advanced non-metastatic prostate cancer?
EBRT combined with ADT.
What are key components of palliative care in advanced prostate cancer?
Pain management, TUR channeling, catheterization, nephrostomy, ADT, radiotherapy.
What are the main types of Androgen Deprivation Therapy (ADT)?
Surgical castration, LHRH agonists, anti-androgens, maximal androgen blockade.
What is maximal androgen blockade (MAB)?
Combination of LHRH agonists and anti-androgens.
Which chemotherapy class is used for metastatic prostate cancer?
Taxane-based chemotherapy (e.g., docetaxel).
What is the role of bisphosphonates in prostate cancer?
Prevents bone loss and reduces skeletal-related events in bone metastases.
What is the gold standard treatment for symptomatic BPH in prostate cancer patients?
Transurethral Resection of the Prostate (TURP).
How does TUR channeling differ from standard TURP?
Creates wider channels for urine flow rather than complete tissue removal.
What is the first-line treatment for spinal cord compression in prostate cancer?
High-dose corticosteroids and urgent radiotherapy or surgery.
What is the purpose of hemostatic radiotherapy?
Controls bleeding from advanced prostate cancer.
What is a common metabolic complication of prostate cancer bone metastases?
Hypercalcemia.
What is the significance of free-to-total PSA ratio?
A lower ratio suggests a higher likelihood of prostate cancer.
What is the TNM staging system used for?
Classifies prostate cancer based on tumor size, nodal involvement, and metastases.
Which patients are candidates for watchful waiting?
Elderly or comorbid patients with low-risk prostate cancer.
What is the role of active surveillance?
Monitors low-risk prostate cancer with periodic PSA tests and biopsies.
What is the most effective curative treatment for localized prostate cancer?
Radical prostatectomy or radiotherapy.
What is the main disadvantage of radical prostatectomy?
Risk of urinary incontinence and erectile dysfunction.
What is the role of pelvic radiotherapy?
Treats lymph node involvement in locally advanced prostate cancer.
Which patients benefit from intermittent ADT?
Patients with biochemical recurrence but no visible metastases.
What is a severe consequence of untreated ureteric obstruction in prostate cancer?
Renal failure.
What is malignant priapism?
A rare condition caused by tumor invasion into penile tissue.
How can anemia develop in prostate cancer patients?
Bone marrow infiltration or chronic disease effects.
What is the first-line imaging for visceral metastases?
Abdominopelvic ultrasound or CT scan.
