Prostate Ca

Question 1

def of prostate ca

Answer 1

malignancy of the prostate
an adenoma carcinoma

most commonly located in the posterior lobe – where it may be felt during a DRE

Question 2

tell me about the epi of prostate ca

Answer 2

most commonly dx male malignancy

typically >65Y

> 80% of men will develop prostate cancer by age 80

Question 3

what are some RF for prostate ca?

Answer 3

1. increased age
2. ethnicity: increase risk in African American and non-White
3. family hx of prostate ca
4. Lynch syndrome
5. genetics - BRCA1/2 and TP53
6. obesity
7. high testosterone
8. history of STI + multiple sexual partners
9. htn

Question 4

tell me about the hormone implications in prostate ca

Answer 4

prostate cancer requires testosterone to grow in most cases

the level of dependance on testosterone impacts the prognosis as it will change the type of therapies available (castrate-resistant vs susceptible)

Question 5

what are red flag signs for prostate ca?

Answer 5

1. Hip or back pain
2. Difficulty urinating
3. Painful or burning urination
4. Blood in the urine

Question 6

what s/s would you expect for prostate ca?

Answer 6

early stages may be asymptomatic

later stages you may be able to palpate the mass on DRE, may have LUTS

may have s/s of growing mass or mets
- spinal cord compression: numbness, tingling, shooting pains, urinary or fecal incontinence

Question 7

common sites of mets for prostate ca?

Answer 7

bladder
LN
bones/spine

Question 8

what does the prognosis look like for prostate cancer?

Answer 8

often a cancer you die with and not of

typically quite treatable

slow growing

5Y survival is 99%

Question 9

how do you ix prostate cancer?

Answer 9

1. history – fhx, personal hx, genetics, RF (STIs, HTN, ethnicity)
2. physical - DRE +/- CVA tenderness or renal exam
3. urine dipstick - r/o other non-malignant ddx
4. imaging: transrectal U/S
5. biopsy
6. bloodwork: cbc, electrolytes, creatinine, urea, ALT/ALP, bilirubin
7. consider imaging for potential mets if symptomatic

Question 10

what met specific imaging would you wanna get for prostate ca?

Answer 10

bone scan - for bone mets
CT - bone mets, LN, bladder
PET- w/ prostate-specific antigen tag ➔ identify lesions if they are prostate ca or another primary

Question 11

talk to me about prostate screening

Answer 11

not recommended unless there is high sus/risk for prostate ca (clinically decided; >45Y + black or fhx of prostate ca)

PSA – is elevated anytime there is inflammation of the prostate – may not be malignancy related

Question 12

how do you tx prostate ca?

Answer 12

depends on the age and symptoms/staging

if older and surgery may be more harm than good can opt for watchful waiting or active surveillance

can do surgery if localized + young and fit for surgery

can do a combination of chemotherapy, radiation, and hormone therapy as tx for more advanced ca or for symptom management

radiation: external beam or brachytherapy
chemotherapy: MT inhibitors
hormone therapy
- LHRH/GnRH agonist ➔ suppresses the production of sex hormones via negative feedback
- LHRH antagonist
- androgen synthesis inhibitors
- 5-alpha reductase inhibitors
- orchiectomy: removal of testes
targeted therapies

Question 13

define the terms castrate resistant prostate ca

Answer 13

Castration-resistant prostate cancer: cancer continues to grow even when testosterone levels are at or below the castrate level