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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
Which is the most common/best method of taking a prostate biopsy?
Template biopsy
26
What are the main strengths of a Template biopsy for prostate cancer ?
- lots of samples taken - can reach ares if the prostrate that a TRUS (transrectal) biopsy cannot
27
What information can a biopsy provide ?
- **type** of tumour - **grade** of tumour - percentage of biopsy is tumour (**how large is it**) - **T stage** of cancer
28
What type of cancer are the vast majority of prostate cancers ?
Adenocarcinoma
29
What is used to grade prostate cancers ?
Gleason Score
30
What does the Gleason Score grading system define ?
the **aggressiveness** of the prostate cancer
31
What Grade on the Gleason Score is considered cancerous ?
3-5
32
Is a high or low Gleason Score indicative of an aggressive cancer ?
**High** Gleason score = more aggressive
33
How is a Gleason Score calculated? What’s it out if ?
2 scores (1-5) added together, out of 10 e.g 3+3 = GS 6
34
What is the lowest Gleason Score indicative of cancer ?
3+3 = GS 6
35
How is the Gleason Score used to grade a tumour ?
*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
What is meant by a cancer ‘stage’ ?
- size of cancer - extent of spread
37
What is the most common tumour staging system ?
TNM system *tumour node metastasis*
38
Why is cancer staging done ?
- helps determine likely **prognosis** - formulate a **treatment plan**
39
What is classified as a stage 1 prostate cancer ?
- localised to the prostate gland (T1a-2a) - confined to less than 1/2 the gland - PSA <10 - GS group 1 (3+3)
40
How many stage 2 prostate cancers are there?
- stage 2A - stage 2B - stage 2C
41
What is defined as a stage 2A prostate cancer ?
- localised to prostate (T1a-2a) - PSA 10-20 - GS grade 2 (3+4)
42
What is defined as a stage 2B prostate cancer ?
- localised to prostate (T1-2) - PSA <20 - GS grade 2 (3+4)
43
What is defined as a stage 2C prostate cancer ?
- localised to prostate (T1-2) - PSA <20 - GS grade 3-4 (4+3/4+4)
44
What are the general characteristics of grade 2A/B/C prostate cancers?
- PSA <20 - occupy just under/half the prostate gland
45
How many types of grade 3 prostate cancers are there ?
- grade 3A - grade 3B - grade 3C
46
What is classified as a grade 3A prostate cancer ?
- localised to (~ half) prostate gland (T1-2) - PSA >20 - GS grade 1-4 (3+3….4+4)
47
What is classified as a grade 3B prostate cancer ?
- expanding out of prostate (T3-4) - GS grade 1-4 (3+3…4+4)
48
What is classified as a grade 3C prostate cancer ?
- GS grade 5
49
What are the general characteristics of grade 3(A/B/C) prostate cancers?
- expanding just out of prostate - PSA >20 - higher end of GS scale
50
What is classified as a stage 4 prostate cancer ?
spread outside of the prostate (local muscles, bones, organs, lymph nodes…)
51
What are the most common places for prostate cancer to spread to ?
Lymph nodes + bones *some spread to liver or lungs*
52
What are the different stages of prostate cancer ?
Stage 1 Stage 2 (A, B, C) Stage 3 (A, B, C) Stage 4
53
What are the 3 prognostic groups for localised prostate cancer ?
- low risk - intermediate risk - high risk
54
What are the parameters of a low risk prognosis group for localised prostate cancer ?
- T1-2a - GS 6 - PSA <10
55
What are the parameters of an intermediate risk prognosis group for localised prostate cancer ?
- T2b-2c - GS 7 - PSA 10-20
56
What are the parameters of a high risk prognosis group for localised prostate cancer ?
- T3a - GS 8-10 - PSA >20
57
What are the treatment options for men with prostate cancer in the low risk prognostic group ?
*all types are available* - active **surveillance** - active treatment (external beam **radiotherapy** or radical **prostatectomy** surgery)
58
What is considered as ‘active surveillance’ treatment ?
- **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
What are the types of radio therapy available for prostate cancer ?
- brachytherapy - external beam radiotherapy
60
What is brachytherapy ?
internal radiotherapy
61
What are the 2 types of brachytherapy ?
- low dose rate - high dose rate
62
What is low dose rate brachytherapy ?
**implant radioactive seeds into prostate** under general anaesthetic
63
What is high dose brachytherapy ?
**insert needles into prostate + send radioactive source** down each needle - not permanent source implanted like in low dose - under general anaesthetic
64
What is external beam radiotherapy ?

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

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