Prostate Flashcards
What is the prostate?
The prostate is a gland of the male reproductive system.
Where is the prostate located?
Located inferior to seminal vesicles and bladder, anterior to rectum, posterior to symphysis pubis.
What are the three different zones of the prostate?
Transitional, Central, and Peripheral.
What passes through the prostate gland?
The urethra passes through the prostate gland.
What does the prostate produce?
Produces liquid part of semen which carries sperm.
What is the main purpose of the prostate?
The main purpose of the prostate.
What is the most common cancer in males?
Prostate cancer.
Which demographic is more likely to be diagnosed with prostate cancer?
African Americans.
What is the age group most affected by prostate cancer?
65 years and older.
What factors increase the risk for prostate cancer?
Age, race, family history, geography, and genetics.
Which inherited mutations can increase prostate cancer risk in men?
Mutations of the BRCA1 or BRCA2 genes.
What other cancers are linked to BRCA1 or BRCA2 mutations?
Breast and ovarian cancers.
What is a notable characteristic of prostate cancer diagnosis in African Americans?
They are more likely to be diagnosed at an advanced stage and have the highest mortality rates.
What are the obstructive symptoms of Benign Prostatic Hypertrophy (BPH)?
Frequency of urination, nocturia, hesitancy, and narrow stream.
Area of indurations on digital rectal exam (DRE).
What does an elevated PSA indicate?
Indicator of possible prostate cancers.
What are the chief complaints from patients with BPH?
Decreased urinary stream, increased frequency, difficulty starting urination, dysuria, hematuria (not as common).
What is a common symptom of prostate cancer?
Obstructive symptoms similar to those of BPH.
At what age should men without a family history of prostate cancer begin screening?
Men without a family history of prostate cancer begin screening at age 50 years.
What is suggested for men with a higher propensity for prostate cancer?
Earlier screening, around age 40 to 45 years, is suggested for men with a higher propensity for development of the disease.
What examinations are mandatory for prostate cancer screening?
Complete physical and rectal examinations are mandatory.
What is the purpose of a rectal examination in prostate cancer screening?
A rectal examination is used to palpate the prostate and feel for any abnormalities or enlargements.
What do PSA tests measure?
PSA tests measure the amount of PSA, a specific protein in the blood that is produced by the prostate.
When are PSA blood levels routinely obtained?
PSA blood levels are routinely obtained in men older than 50 years.
What does tracking PSA levels over time allow physicians to do?
Tracking of PSA levels over time allows physicians to monitor rising levels and indicate a problem even before a tumor is detectable.
What is the standard method for diagnosing prostatic carcinoma?
A transrectal ultrasound-guided needle biopsy is the standard method of diagnosis.
What are the stages of bladder cancer mentioned?
The stages mentioned are T1a, T1b, T1c, and T2.
What initial assessments are part of the diagnostic workup?
History and physical exam, digital rectal exam, and lab studies including PSA.
What radiological studies are used in the diagnostic workup?
CT of pelvis, chest X-ray, bone scan, ultrasound, MRI, and PET.
What does stage T1b indicate?
Cancer in the back lobe of the prostate.
What does stage T1a indicate?
Cancer in the front lobe of the prostate.
What does stage T2 indicate?
Cancer in the back lobe of the prostate.
What is the most common type of prostate carcinoma?
Adenocarcinoma
Where do most prostate carcinomas develop?
In the peripheral zones of the prostate.
What is the pattern of regional metastasis for prostate cancer?
Metastasis occurs to pelvic lymph nodes.
How does lymphatic spread from the prostate occur?
It is orderly.
What nodes are involved in the lymphatic spread from the prostate?
Periprostatic and obturator nodes.
What nodes follow the periprostatic and obturator nodes in lymphatic spread?
External iliac, hypogastric, common iliac, and para-aortic nodes.
Where can distant metastasis occur in prostate cancer?
To the bones of the pelvis and vertebral column.
What imaging techniques are used for detecting bone metastasis?
Bone scan and PET.
What nodes are mentioned in relation to prostate cancer?
Presacral nodes.
What does the Gleason System measure?
The aggressiveness of the tumor done by biopsy.
How is the Gleason score determined?
By assigning grades to the 2 areas that make up most of the cancer and adding them together.
What is the score range of the Gleason System?
Based on a score of 2-10.
What is the typical Gleason score for most prostate cancers?
Most prostate cancers score a 6-7.
What does a higher Gleason score indicate?
The more poorly differentiated the tumor.
How does the Gleason score correlate with prognosis?
Lower scores are more slowly growing nonaggressive tumors, while higher scores are more invasive.
What are some examples of Gleason patterns?
6, 3+4=7, 4+3=7, 4+4=8, 9-10.
What are the three groups of prostate cancers based on the Gleason score?
- Cancers with a Gleason score of 6 or less may be called well-differentiated or low-grade.
- Cancers with a Gleason score of 7 may be called moderately-differentiated or intermediate grade.
- Cancers with Gleason scores of 8 to 10 may be called poorly-differentiated or high-grade.
What characterizes well-differentiated prostate cancer?
Cancers with a Gleason score of 6 or less.
May be called low-grade.
What characterizes moderately-differentiated prostate cancer?
Cancers with a Gleason score of 7.
May be called intermediate grade.
What characterizes poorly-differentiated prostate cancer?
Cancers with Gleason scores of 8 to 10.
May be called high-grade.
What is the first pattern in Gleason’s Pattern Scale?
Small, uniform glands.
Characterizes well-differentiated cancer.
What is the second pattern in Gleason’s Pattern Scale?
More space (stroma) between glands.
Characterizes moderately-differentiated cancer.
What is the third pattern in Gleason’s Pattern Scale?
Distinctly infiltration of cells from glands at margins.
Characterizes poorly-differentiated cancer.
What is the fourth pattern in Gleason’s Pattern Scale?
Irregular masses of neoplastic cells with few glands.
What is the fifth pattern in Gleason’s Pattern Scale?
Lack of or occasional glands, sheets of cells.
What is the treatment approach for early-stage prostate cancer?
Observation is often used as early-stage prostate cancer usually grows slowly, and some men may never need treatment.
What is the common surgical treatment for localized prostate cancer?
Surgery is the common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
What is a radical prostatectomy?
In a radical prostatectomy, the surgeon removes the entire prostate gland plus some surrounding tissue, including the seminal vesicles.
What is the most recent advancement in prostate surgery?
The most recent advancement is the robotic-assisted laparoscopic prostatectomy.
What are common side effects of prostate cancer surgery?
Side effects include difficulty controlling urine flow and a high risk of impotence.
What is brachytherapy?
Brachytherapy is generally used only in men with early-stage, low-grade prostate cancer.
When is brachytherapy combined with external radiation used?
It is sometimes an option for men at higher risk of the cancer growing outside the prostate.
What is the most common type of external beam radiation therapy for prostate cancer?
IMRT (Intensity-Modulated Radiation Therapy) is the most common type.
What role does hormone therapy play in prostate cancer treatment?
Hormone therapy is considered ineffective alone but helps halt the proliferation of prostate cancer cells by cutting off testosterone supply.
Is chemotherapy a standard treatment for early prostate cancer?
Chemotherapy is not a standard treatment for early prostate cancer but is used in patients with metastatic disease.
What is HDR-Brachytherapy?
HDR-Brachytherapy involves interstitial brachytherapy performed under spinal or general anesthesia, using a grid or template against the perineum with the patient in the dorsal lithotomy position.
How are needles directed during HDR-Brachytherapy?
Transrectal ultrasound scan is used to direct the needles, which can be preloaded or attached to the Mick applicator that deposits permanently placed radioactive seeds.
What is required to determine if a patient is a candidate for HDR-Brachytherapy?
An Arch Study is needed to scan the patient.
What imaging is used to assess the size of the pubic arch?
A CT scan is used to see the size of the pubic arch.
What condition must the prostate meet for HDR-Brachytherapy?
The prostate must be small enough for needles to penetrate through the pubic arch.
What can be done if the prostate is too large for HDR-Brachytherapy?
Drugs can be taken to shrink the prostate.
What are the commonly used permanent isotopes in brachytherapy?
The commonly used permanent isotopes are Iodine 125, Palladium 103, and Cesium 131.
What is the usual dose for Iodine 125 implant in brachytherapy?
The usual dose for implant alone with Iodine 125 is 160 Gy to the prostate plus margin.
When do patients return for a CT scan after brachytherapy implantation?
Patients return for a CT scan after a month and then every 3 months for the first year.
What organs are involved in the brachytherapy procedure?
The involved organs are the Prostate, Bladder, and Urethra.
What type of cancer is treated with brachytherapy seeds?
Brachytherapy seeds are used to treat Prostate Cancer.
What is required from patients before EBRT patient simulation?
Patients need to have a full bladder and empty rectum before simulation.
What is the positioning of the patient during EBRT simulation?
The patient is supine.
What equipment is used for immobilization of the legs and hips?
Vac-Loks are used for legs/hip.
What is used to prevent hand movement during simulation?
A blue ring is used for hands to prevent movement.
What is used to support the head during EBRT simulation?
A head cushion is used.
What is the thickness of CT images taken of the pelvis?
CT images of the pelvis are taken in 3-5-mm thicknesses.
What areas are scanned during the CT imaging for EBRT simulation?
Scanning is done superiorly below the diaphragm and inferiorly to mid-femur.
What is another name for Prostate Localization?
‘Cone Beam CT’.
When is Prostate Localization primarily used?
It is great when only treating the prostate bed.
Is Prostate Localization commonly used for daily treatment?
No, it is not used much for daily treatment but rather when implanting seeds or HDR needles.
What percentage is associated with the treatment method mentioned?
40%.
How are gold seeds implanted in the prostate?
Implanted within the prostate gland.
How is the prostate located for treatment?
A catheter with contrast is inserted in the penis to the penile bulb, which is 1 cm below the prostate. Locate prostate by going 1 cm superior.
Why is daily localization of the prostate important?
The prostate’s location should be verified daily before treatment due to its position inferior to the bladder and anterior to the rectum.
What factors can change the prostate position from day to day?
Bladder and rectal filling, along with slight differences in patient positioning on the treatment table, can change the prostate position.
How can the prostate location be verified?
Verification can be done in many ways, including treating patients with a full bladder.
What is the benefit of treating patients with a full bladder?
A full bladder helps visualize the bladder-prostate interface and moves the bladder out of the radiation field.
What is the outcome of proper alignment of the prostate within the radiation field?
Proper alignment ensures the correct dose is delivered, marginal misses are avoided, and the bladder and rectum are maximally spared.
What technique can increase the space between the rectum and the prostate?
The injection of a material into the peritoneum can increase the space between the rectum and the prostate.
What is an example of a material used to create space between the rectum and prostate?
Hydrogel is an example of a spacer used for this purpose.
What is the required state of the bladder when treating prostate cancer?
The bladder must be FULL.
What is the required state of the rectum when treating prostate cancer?
The rectum should be EMPTY.
Why is a full bladder important during prostate cancer treatment?
A full bladder pushes the prostate in the same location every day while eliminating the bladder from the treatment field.
Why is an empty rectum important during prostate cancer treatment?
An empty rectum ensures it will be out of the treatment field as much as possible.
What treatment technique is most widely used for prostate cancer?
Image-guided radiation therapy (IGRT) has become the most widely used treatment technique.
What has allowed for dose escalation and tighter margins around the prostate?
Exact daily alignment has become more important than ever due to treatment planning.
What must be constructed to determine the volume of critical organs receiving high doses?
Dose-volume histograms (DVHs) must be constructed.
What is the typical number of oblique treatment angles used in beam design?
Beam design typically uses five or six oblique treatment angles.
What does IMRT specify?
IMRT specifies the chosen dose to the tumor volume and acceptable dose levels for surrounding healthy structures.
What are the common treatment fields used in beam arrangement?
A common technique is five fields: right and left posterior oblique fields, right and left anterior oblique fields, and a posterior-anterior field.
How are treatment fields shaped for prostate cancer?
Treatment fields are shaped or conformed to the prostate with MLCS.
What advanced techniques are used to spare healthy tissue?
Volumetric-modulated arc therapy (VMAT) and tomotherapy are used to further spare healthy tissue.
How is treatment delivered in VMAT and tomotherapy?
In these techniques, gantry and collimator movement happen simultaneously to deliver treatment through a single or multiple arcs.
What is CyberKnife used for?
CyberKnife is an SRS/SBRT treatment option for patients with low grade tumors.
What is proton therapy?
Proton therapy is a form of external beam radiation therapy used in the treatment of many cancers, including prostate cancer.
How does proton therapy compare to x-ray beam therapy?
Compared with an x-ray beam, a proton beam has a low ‘entrance dose’, a high dose designed to cover the entire tumor, and no ‘exit dose’ beyond the tumor.
What is the advantage of proton therapy’s unique characteristics?
Proton therapy can deposit a radiation dose in a precise manner at a specific location within the body, minimizing damage to surrounding healthy tissue.
What is the daily dose for radiation?
180cGy-200cGy
What is the total dose for the whole prostate?
7560cGy-7920cGy
What is the total dose for the prostate bed?
6400cGy-6800cGy
What are the acute side effects for prostate?
Diarrhea, abdominal cramping, rectal discomfort, occasional rectal bleeding, dysuria, nocturia, UTIs, erythema.
What are the chronic side effects for prostate?
Sexual impotence, erectile dysfunction.
Observed in 30-60% of men treated with EBRT and 20-30% of men treated with interstitial implant.
