Endocrine Related Cancer: Prostate

Question 1

how many men show incidence of benign prostatic hyperplasia (BPH)?

Answer 1

70% of men > 50 and prob. 100% of men >80

Question 2

what is the pathological description of pT2 on the Gleasons scores?

Answer 2

Tumor confined to the prostate

Question 3

what is the pathological description of pT2a on the Gleasons scores?

Answer 3

Tumor affects one-half of one lobe or less

Question 4

what is the pathological description of pT2b on the Gleasons scores?

Answer 4

Tumor affects more than one-half of one lobe but not both lobes

Question 5

what is the pathological description of pT2c on the Gleasons scores?

Answer 5

Tumor affects both lobes

Question 6

what is the pathological description of pT3 on the Gleasons scores?

Answer 6

Tumor extends beyond the prostate

Question 7

what is the pathological description of pT3a on the Gleasons scores?

Answer 7

Tumor extends beyond the prostate

Question 8

what is the pathological description of pT3b on the Gleasons scores?

Answer 8

Tumor invades seminal vesicle(s)

Question 9

what is the pathological description of pT4 on the Gleasons scores?

Answer 9

Tumor invades the bladder, rectum

Question 10

what is the link between fat and prostate cancer?

Answer 10

strong association but no specific fat components identified.

Question 11

what is the link between fibre and prostate cancer?

Answer 11

decreased fibre in diet associated with prostate cancer.

Question 12

what is the link between phytoestrogens and prostate cancer?

Answer 12

very high in oriental diet. May disturb androgen-oestrogen balance

Question 13

what are the risk factors associated with prostate cancer?

Answer 13

fat

fibre

phytoestrogens

oestrogens

Question 14

what is the prostate highly dependent on?

Answer 14

androgen

Question 15

which is more important in the mechanism of disease - testosterone or dihydrotestosterone?

Answer 15

Dihydrotestosterone

Question 16

how is testosterone converted to dihydrotestosterone?

Answer 16

Conversion (via 5a-reductase) occurs in prostate –> maintenance & growth of glandular epithelium.

Question 17

how are the effects of dihydrotestosterone and testosterone mediated?

Answer 17

androgen receptors

Also a ligand-dependent transcription factor

Question 18

how can prostate cancer progress to hormone independent form?

Answer 18

mutation of androgen rec. (AR) gene –>
responds to other steroids or to growth factors or cytokines;
amplification of rec. or cofactors;

or bypass of AR pathway.

Question 19

what is the treatment for prostate cancer?

Answer 19

• Prevention/early management (BPH): finasteride (antiandrogens); vitamin E/Se supplements
• Early stages may respond to local treatment e.g., radiation therapy, surgery (prostate reduction)
• Removal of androgens induces apoptosis in epithelium –> involution of tissue. Effective even in metastatic stage.

Question 20

how is removal of androgens achieved?

Answer 20

Castration - radical & now rel. uncommon in UK & USA.

Inhibition of 5DHT reductase e.g. by finasteride.

GnRH (ant)agonists to reduce LH & FSH & hence T and thus DHT.

Cyproterone acetate: both anti-androgenic in prostate & inhibits LH release.

Combination of local anti-androgen with anti-GnRH treatment seems promising.

Question 21

what happens if prostate cancer is further advanced?

Answer 21

chemo/radiotherapy required

Question 22

what is prostate-specific antigen used for?

Answer 22

marker for progress of the disease

Question 23

what level is the threshold indicator of disease?

Answer 23

4ng/ml