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Sem 4, case 8 (prostate cancer) > overview of prostate cancer (mini learning) > Flashcards

overview of prostate cancer (mini learning) Flashcards

1
Q

How big - roughly - is the prostate?

A

size of a walnut

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2
Q

What is the main function of the prostate ?

A

produce seminal fluid

fluid in semen that protects, supports and transports sperm

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3
Q

What is the function of seminal fluid ?

A

fluid in semen that protects, supports and transports sperm

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4
Q

Where is the prostate located ?

A
  • surrounding urethra
  • under bladder
  • in front of rectum
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5
Q

What are the most common risk factors for prostate cancer ?

A
  • age = very rate before age of 40
  • ethnicity = more common in African American men
  • Family history
  • nationality = more common in north america/northwest europe
  • genetics (BRCA1/2 gene)
  • diet, exercise, obesity
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6
Q

What is the most common age range for prostate cancer diagnosis ?

A

> 65

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7
Q

What is the biggest risk factor for prostate cancer ?

A

age

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8
Q

Which genes are associated with prostate cancer ?

A

BRCA 1 and BRCA 2

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9
Q

Roughly how many men in the UK will ahve a prostate cancer diagnosis in their life ?

A

1 in 8

~ 45,000 men a year

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10
Q

Is the survival prognosis of prostate cancer good or bad ?

A

quite good !

84% of men live >10 years past diagnosis

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11
Q

Which age range of prostate cancer diagnoses have best chance of survival ?

A

60-69

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12
Q

What are the main symptoms of prostate cancer ?

A

local (lower urinary tract)
- obstructive
- irritative

metastatic
- pain …

systemic
- fatigue, weight loss …

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13
Q

How is prostate cancer diagnosed ?

A
  • History
  • DRE (finger up bum)
  • PSA
  • Multiparametric MRI
  • Biopsy
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14
Q

What would a PSA test show if prostate cancer is present ?

A

elevated PSA levels

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15
Q

What can increase PSA levels ?

A
  • prostate cancer
  • benign prostate hypertrophy (BPH)
  • Age
  • prostatitis/inflammation
  • recent ejaculation
  • DRE
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16
Q

What can decrease PSA levels ?

A
  • medicine (finasteride/dutasteride)
  • obesity
  • herbal preparations
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17
Q

Is there a screening programme for prostate cancer ?

A

No

PSA in high risk categories with strong Fx

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18
Q

Why is PSA not used as a common screening test for prostate cancer ?

A
  • not sensitive enough
  • not specific enough

= over diagnoses

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19
Q

What is the step before a biopsy in the diagnosis of prostate cancer ?

A

multiparametric MRI

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20
Q

Is an MRI a good or bad method in the diagnosis of prostate cancer ?

A

They’re very good at picking up abnormalities in the prostate, so a normal scan would most likely be fine

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21
Q

What are the strengths of using a multiparametric MRI before biopsy of the prostate ?

A
  • good at picking up abnormalities = some men i’ll be spared from a biopsy if scan is normal
  • can locate the tumour = biopsy will be more precise
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22
Q

What are the 2 methods of prostate biopsy ?

A
  1. Transrectal ultrasound guided biopsy (TRUS)
  2. Template biopsy
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23
Q

How is a TRUS (transrectal ultrasound guided) prostate biopsy performed ?

A

biopsy taken through rectal wall under ultrasound guidance and local anaesthetic

12 samples taken

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24
Q

How is a Template prostate biopsy taken ?

A

Transperineal under local or general anaesthetic

lots of samples taken

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25
Q

Which is the most common/best method of taking a prostate biopsy?

A

Template biopsy

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26
Q

What are the main strengths of a Template biopsy for prostate cancer ?

A
  • lots of samples taken
  • can reach ares if the prostrate that a TRUS (transrectal) biopsy cannot
27
Q

What information can a biopsy provide ?

A
  • type of tumour
  • grade of tumour
  • percentage of biopsy is tumour (how large is it)
  • T stage of cancer
28
Q

What type of cancer are the vast majority of prostate cancers ?

A

Adenocarcinoma

29
Q

What is used to grade prostate cancers ?

A

Gleason Score

30
Q

What does the Gleason Score grading system define ?

A

the aggressiveness of the prostate cancer

31
Q

What Grade on the Gleason Score is considered cancerous ?

A

3-5

32
Q

Is a high or low Gleason Score indicative of an aggressive cancer ?

A

High Gleason score = more aggressive

33
Q

How is a Gleason Score calculated? What’s it out if ?

A

2 scores (1-5) added together, out of 10

e.g 3+3 = GS 6

34
Q

What is the lowest Gleason Score indicative of cancer ?

A

3+3 = GS 6

35
Q

How is the Gleason Score used to grade a tumour ?

A

grade 1 = 3+3 (GS 6)
grade 2 = 3+4 (GS 7)
grade 3 = 4+3 (GS 7)
grade 4 = 4+4 (GS 8)
grade 5 = 4+5, 5+4, 5+5 (GS 9/10)

grade 3-5 are considered cancerous

36
Q

What is meant by a cancer ‘stage’ ?

A
  • size of cancer
  • extent of spread
37
Q

What is the most common tumour staging system ?

A

TNM system

tumour node metastasis

38
Q

Why is cancer staging done ?

A
  • helps determine likely prognosis
  • formulate a treatment plan
39
Q

What is classified as a stage 1 prostate cancer ?

A
  • localised to the prostate gland (T1a-2a)
  • confined to less than 1/2 the gland
  • PSA <10
  • GS group 1 (3+3)
40
Q

How many stage 2 prostate cancers are there?

A
  • stage 2A
  • stage 2B
  • stage 2C
41
Q

What is defined as a stage 2A prostate cancer ?

A
  • localised to prostate (T1a-2a)
  • PSA 10-20
  • GS grade 2 (3+4)
42
Q

What is defined as a stage 2B prostate cancer ?

A
  • localised to prostate (T1-2)
  • PSA <20
  • GS grade 2 (3+4)
43
Q

What is defined as a stage 2C prostate cancer ?

A
  • localised to prostate (T1-2)
  • PSA <20
  • GS grade 3-4 (4+3/4+4)
44
Q

What are the general characteristics of grade 2A/B/C prostate cancers?

A
  • PSA <20
  • occupy just under/half the prostate gland
45
Q

How many types of grade 3 prostate cancers are there ?

A
  • grade 3A
  • grade 3B
  • grade 3C
46
Q

What is classified as a grade 3A prostate cancer ?

A
  • localised to (~ half) prostate gland (T1-2)
  • PSA >20
  • GS grade 1-4 (3+3….4+4)
47
Q

What is classified as a grade 3B prostate cancer ?

A
  • expanding out of prostate (T3-4)
  • GS grade 1-4 (3+3…4+4)
48
Q

What is classified as a grade 3C prostate cancer ?

A
  • GS grade 5
49
Q

What are the general characteristics of grade 3(A/B/C) prostate cancers?

A
  • expanding just out of prostate
  • PSA >20
  • higher end of GS scale
50
Q

What is classified as a stage 4 prostate cancer ?

A

spread outside of the prostate (local muscles, bones, organs, lymph nodes…)

51
Q

What are the most common places for prostate cancer to spread to ?

A

Lymph nodes + bones

some spread to liver or lungs

52
Q

What are the different stages of prostate cancer ?

A

Stage 1
Stage 2 (A, B, C)
Stage 3 (A, B, C)
Stage 4

53
Q

What are the 3 prognostic groups for localised prostate cancer ?

A
  • low risk
  • intermediate risk
  • high risk
54
Q

What are the parameters of a low risk prognosis group for localised prostate cancer ?

A
  • T1-2a
  • GS 6
  • PSA <10
55
Q

What are the parameters of an intermediate risk prognosis group for localised prostate cancer ?

A
  • T2b-2c
  • GS 7
  • PSA 10-20
56
Q

What are the parameters of a high risk prognosis group for localised prostate cancer ?

A
  • T3a
  • GS 8-10
  • PSA >20
57
Q

What are the treatment options for men with prostate cancer in the low risk prognostic group ?

A

all types are available

  • active surveillance
  • active treatment (external beam radiotherapy or radical prostatectomy surgery)
58
Q

What is considered as ‘active surveillance’ treatment ?

A
  • regular monitoring
  • PSA (every 3 months)
  • DRE (6months after diagnosis)
  • mpMRI (year after diagnosis)
  • Biopsy (year after diagnosis)

used to closely monitor the cancer and intervene if necessary later

59
Q

What are the types of radio therapy available for prostate cancer ?

A
  • brachytherapy
  • external beam radiotherapy
60
Q

What is brachytherapy ?

A

internal radiotherapy

61
Q

What are the 2 types of brachytherapy ?

A
  • low dose rate
  • high dose rate
62
Q

What is low dose rate brachytherapy ?

A

implant radioactive seeds into prostate under general anaesthetic

63
Q

What is high dose brachytherapy ?

A

insert needles into prostate + send radioactive source down each needle

  • not permanent source implanted like in low dose
  • under general anaesthetic
64
Q

What is external beam radiotherapy ?

A

Sem 4, case 8 (prostate cancer) (4 decks)

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