Oncology Flashcards
What is the most common cancer in men?
Prostate
What is the 1st & 2nd most common causes of death due to cancer in men?
1st= Lung cancer
2nd= Prostate cancer
What is the screening programme for prostate cancer?
No screening programme
Men request ‘informed choice’
What is the most common type of prostate cancer?
Adenocarcinoma in the peripheral zone
What is PSA raised by?
UTI
Cancer
BPH
Vigorous DRE
Cycling/horse-riding
Prostatitis
Ejaculation
What are the symptoms of prostate cancer?
Asymptomatic
LUTS
- Voiding symptoms rather than retention (intermittency/hesitancy/weak flow/terminal dribbling)
Pain (back/perineal/testicular)
Haematuria/haematospermia
Bone pain (metastases)
Abnormal DRE
What investigations do you do if you suspect prostate cancer?
PSA (>4)
Urine dipstick (rule out infection)
DRE
Abdominal exam
Spinal exam (body pain)
Lower limb neurological exam
Multiparametric MRI of prostate
Transperineal template biopsy
Bone scan
What PSA level indicates metastases?
> 100
If you have a low PSA but MRI indicates prostate cancer, the low PSA is due to the fact that the cancer is so advanced the cells can no longer secrete PSA
What is a normal DRE?
Smooth
Peach like
Get over the top of it
What is a DRE with BPH like?
Smooth
Loss of sulcus
Cannot get over the top of it
What is a DRE with prostate cancer like?
Craggy (walnut like)
Hard
Nodular
Asymmetrical
Enlargement with loss of median sulcus
What are the risk factors for prostate cancer?
BRCA1/2/HPC1 mutations
High fat, low fibre diet
FHx
Increased age
Obesity
Afro-caribbean ethnicity
What are the different zones of the prostate?
Central
Peripheral
Transitional
Which zone of the prostate does BPH affect?
Transitional zone
- urethra runs through here
How do you stage prostate cancer?
TNM staging
How do you grade prostate cancer?
Gleason Grading System
Biopsy result: 1-5 (how differentiated it is, 5 is worst)
How do you manage prostate cancer?
CURATIVE
Conservative: active surveillance (monitor PSA/DRE/symptoms)
Medical: radiotherapy (external beam/brachytherapy) and hormone therapy
Surgical: Robotic radical prostatectomy
PALLIATIVE
Conservative: watchful waiting until symptoms progress
Medical: differed hormone therapy (anti-androgen: goserelin) or chemotherapy (docetaxel)
Surgical: Bilateral nephrostomy (retention)
