Prostate Ca Flashcards
T1/2
localised prostate cancer
T3/4
locally advanced prostate cancer
Treatment options for T1/2 prostate ca
- conservative: watch and wait
- radical prostatectomy
- radiotherapy: external beam and brachytherapy
Treatment options for T3/4 prostate ca
- hormonal therapy
- radical prostatectomy
- radiotherapy (external beam /brachytherapy)
Complications of prostate ca radiotherapy
- proctitis
- increased risk of bladder, colon, and rectal cancer
What hormone are we aiming to reduce in prostate cancer?
androgens
What hormone therapies can be used to suppress androgens?
- synthetic GnRH agonist or antagonists
- bicalutamide - non-steroidal anti-androgen which blocks the androgen receptor
- cyproterone acetate - steroidal anti-androgen, prevents DHT binding from intracytoplasmic proteins
- abiraterone
androgen synthesis inhibitor
how do GnRH agonists work?
- paradoxically lower LH levels longer term by causing overstimulation
=> disrupt hormonal feedback
testosterone rises initially for 2-3 weeks before falling
Side effect of GnRH agonists
Initial rise in testosterone causes ‘tumour flare’.
=> stimulation of prostate cancer growth may result in bone pain, bladder obstruction and other symptoms
How is “tumour flare” with GnRH agonists managed?
Cover first few weeks with an anti-androgen
GnRH antagonists do NOT display the “tumour flare” phenomenon. TRUE/FALSE?
TRUE
When is a bilateral orchidectomy used in hormal Tx of prostate ca?
To rapidly reduce testosterone levels
Upper limits of PSA in 50-59, 60-69 and >70y age groups
50-59 years 3.0
60-69 years 4.0
> 70 years 5.0
What other than prostate ca can raise a PSA level
BPH
prostatitis
UTI
ejaculation (in previous 48 hrs)
vigorous exercise (in previous 48 hours)
urinary retention
instrumentation of the urinary tract
