Prostate Flashcards

Question

What is watchful waiting with regards to prostate cancer?

Answer 1

Done in frail men with complicated co-morbidities who wont survive treatment. Monitoring less regular and in GP setting

Answer 2

``` Haematospermia Prostatitis Urinary sepsis Urinary retention Rectal bleeding ```

Answer 3

Not reliable Doesn't reduce deaths from cancer Harm associated with over diagnosis

Answer 4

Adenocarcinomas Much rarer can be transitional cell, squamous cell or neuroendocrine Most in peripheral zone Some in central or transitional

Answer 5

LUTS: Nocturia, freq, hesitancy, urgency, dribbling, overactive bladder, retention Visible haematuria Abnormal DRE - hard, nodular, enlarged, asymmetrical Symptoms of advanced disease e.g. haematuria, blood in semen, lower back pain, bone pain, weight loss

Answer 6

Lower urinary tract symptoms Haematuria Unexplained symptoms which may be due to advanced prostate cancer e.g. back pain, bone pain, weight loss Erectile dysfunction Other reasons to be concerned e.g. elevated PSA

Answer 7

Active or recent UTI - last 6 weeks Recent ejaculation, anal sex or prostate stimulation Vigorous exercise for 48 hrs Urological intervention in past 6 weeks

Answer 8

Prostate specific antigen protein produced by prostate epithelial cells

Answer 9

All men with suspected prostate cancer Abnormal prostate on DRE PSA level elevated above age-specific range

Answer 10

Multiparametric MRI Likert-score - 5 point score on impression of the scan: 1. Clinically significant cancer highly unlikely to be present 2. Clinically significant cancer is unlikely to be present 3. Chance of clinically significant cancer is equivocal 4. Clinically significant cancer is likely to be present 5. Clinically significant cancer is highly likely to be present

Answer 11

To those with a Likert score of 3 or greater Biopsy guided by MRI images and use of USS Those who do not have biopsy with Likert score of 1/2 and raised PSA - ongoing active surveillance

Answer 12

TNM staging | Gleason score gives histological grade

Answer 13

Chemical castration Initially causes increase in LH/FSH release from anterior pituitary Persistence then causes downregulation of receptors on pituitary leading to reduced LH/FSH e.g. Goserelin/Zoladex

Answer 14

Low risk - active surveillance, radical prostatectomy, radical radiotherapy Intermediate risk disease - radical prostatectomy or radiotherapy, active surveillance in those that decline this High risk - radical prostatectomy, or radical radiotherapy, do not advise active surveillance

Answer 15

``` Prostate cancer Normal benign asymmetry Benign prostatic hypertrophy Prostatitis Cyst Prior TURP/biopsy scar ```

Answer 16

FBC - anaemia, pancytopenia due to bone marrow involvement or chronic disease PSA ALP, Ca - bone mets U&Es - kidney function, bladder obstruction LFTs, albumin - ability to treat with anti-androgen medication LDH - metastatic disease

Answer 17

1 - normal prostate, uniform glands, little stroma 2 - well formed glands 3 - variable sized glands 4 - incomplete gland formation, cell nests 5 - grossly abnormal, no gland formation

Answer 18

6 or less - low grade, slow growth, may not need tx 7 - intermediate grade, growth and spread at mod pace 8, 9, 10 - high grade, fast growth, tx needed

Answer 19

Local - via thinner weaker capsular walls, to bladder neck, seminal vesicles T3 Lymphatic via obturator, hypogastric, presacral and external iliac nodes Haematogenous - distant mets to the bone, sometimes rarely liver or lungs

Answer 20

Curative, may be as efficacious as surgery, no surgery necessary whereas no pathological staging available longer treatment course SEs - fatigue, nausea, anorexia, irritative bowel and bladder symptoms

Answer 21

Single session, if high risk may need only a few Contraindicated if Large prostate, unfit for anaesthesia, recent TURP procedure

Answer 22

``` Impotency Loss of libido Anaemia Nausea and vomiting CNS, neurological changes Galactorrhoea Muscle atrophy Osteoporosis Delayed testosterone recovery Increased AST/LDH Gynaecomastia ```