Prostate Flashcards
Anatomy, Oncology & Management
Name the structures of the male reproductive system
Penis
Scrotum
Testes x2
Epididymis x2
Vas deferens x2
Seminal vesicles x2
Ejaculatory duct
Prostate gland
Where does the seminal fluid come from?
70% from the seminal vesicles
25% from the prostate gland
5% testes
What is the purpose of the seminal fluid
It is to aid in the motility and transport of sperm to the egg by…
- containing energy source for sperm (fructose)
- alkaline ph to neutralise slightly acidic vagina
- contain mucous to protect the sperm during travel
What is the ejaculatory fluid made up of?
Spermatozoa,
Mucus
Alkaline fluid
Fructose
Prostoglandins
What is BPH? and what does it cause?
Benign prostatic hyperplasia
Enlarged prostate - Causes urinary problems, difficulty passing urine due to compression of the urethra, Compression of the internal urethral sphincter so feeling as if need to go for a wee.
Where is the prostate gland located?
At the base of the bladder (inf)
Posterior to the pubis symphysis
Anterior to the rectum
Surrounds the first part of the urethra
What protein does the prostate gland produce and what is its function?
PSA - prostatic specific antigen
It declots the spermatozoa - prevents the sperm from sticking together
What level of PSA indicates need for clinical investigation?
Over 4ng/ml of PSA warrants the need for investigation of prostate cancer.
What tissue is the prostate gland made up of?
Encapsulated by fibrous/connective tissue
Contains smooth muscle tissue that is innervated by sympathetic nerves to stimulate muscle contraction of the secretion of fluid into the urethra
Contains glandular tissue - secretes fluid that makes up the seminal fluid
What are the different zones of the prostate gland
Central zone- 25%
Transitional zone - 10%
Peripheral zone - 65% main body of glandular tissue
What is the main lymphatic drainage of the prostate gland?
Obturator nodes
Internal iliac nodes
External iliac
Pre-sacral
Para-aortic
Which hormone stimulates growth of the prostate?
Testosterone
What is the blood supply to the prostate?
Internal iliac artery
What is the 10 year survival for prostate cancer?
98%
List 4 causes of prostate cancer:
- Age (increased risk as you get older)
- Ethnicity (more common in black males than white)
- Family history of prostate cancer
- Obesity
What is the most common type of prostate cancer?
Adenocarcinoma
What zone do most prostate cancers arise in ?
Peripheral zone
List 5 signs and symptoms that may present with prostate cancer:
- Nocturia - urinating at night
- Dysuria - difficulty passing urine
- Haematuria - blood in the urine
- Increased frequency of urination
- Never feeling fully empty
What clinical investigations can be done to diagnose prostate cancer in somebody?
- Digital rectal examination - identify lumps or hard areas
- PSA blood test check for elevated levels
- Biopsy
- CT, MRI, PET scan to check staging and spread
What type of biopsy is taken of the prostate?
- Transrectal ultrasound guided biospy (needle inserted through rectum)
- Transperineal biopsy (needle inserted through peritoneum.
What staging system is used for prostate cancer?
TNM
What grading system is used for prostate cancer?
Gleason grading
What are the different Tumour types of prostate cancer?
T1- contained in the prostate but too small to feel or visualise on scan
T2-contained within prostate but can be felt or seen on scan
T3- Have spread beyond the prostate, may be growing into tissues (seminal vesicles)
T4- Cancer has spread to nearby organs (bladder, rectum, muscle)
What is meant by
1. early/localised
2. locally advanced
3. advanced/metastatic
prostate cancer
T1/T2 are early/localised prostate cancer - these have not grown out of the prostate. - these are stage 1&2
T3/T4 - are locally advanced prostate cancer these have grown outside the prostate - these are stage 3 & 4
Advanced/metastatic prostate cancer has spread to another area in the body - these are always stage 4
How does gleason grading work?
The doctor assesses all of the biopsy tissue and decides on:
Most common grade (1-5)
Highest grade (1-5)
These are then added together to give a gleason score.
Depending on the gleason score they are put into a grade group from 1-5.
What do the following gleason scores indicate?
6 or below -
7 -
8-10 -
6 or below - slow growing
7 - between fast and slow growing
8-10 - fast growing
What are the risk groups for prostate cancer and what do they take into account?
5 different risk groups
CPG1 - CPG 5
- grade score
-PSA level - stage
What tool is used to assess risk group for prostate cancer?
Cambridge prognostic group
When might a patient be suitable for active surveillance?
asymptomatic
Low risk
localised/early stage
life limiting comorbidities
What % of patients undergoing active surveillance go onto require treatment?
30%
What is the name surgical removal of the prostate and when might a patient have this?
Radical Prostatectomy
- your cancer is localised to the prostate
- your cancer is locally advanced
- you are fit and healthy enough to undergo a fairly invasive procedure.
In what cases is radiotherapy given for prostate cancer?
Alone for Localised or locally advanced
Given with hormone therapy
Palliaitive symptom relief for Metastatic
when may chemotherapy be given for prostate cancer?
In metastatic disease as a systemic treatment. To treat spread.
How does hormone therapy work for prostate cancer?
It blocks or lowers the amount of testosterone in the body which slows down/prevents the growth of hormone cancer.
Give two examples of hormone therapy
LH blockers
GnRH blockers
When may you have hormone therapy for prostate cancer?
With radiotherapy for localised/locally advanced cancer
Alone - this will not cure it but may be option if unsuitable for other radical txt options, or if cancer has spread.
With chemotherapy - for metaststatic disease
For recurrent disease - after surgery or radiotherapy
What tissue is removed from the body during a radical prostatectomy?
Prostate gland + surrounding tissue
Seminal vesicles
Nearby lymph nodes
When may a patient have brachytherapy for prostate cancer?
If the cancer is localised or locally advanced
If the patient has already had EBRT and the cancer has come back
