Prostate Cancer (1) Flashcards
What do they rely on to grow?
What are its risk factors?
How does it present?
➊ Androgens
N.B. > 75% originate in the peripheral zone.
➋ • Increasing age
• Family hx
• Afro-Caribbean
• Increased testosterone - e.g. use of anabolic steroids
➌ • May be asymptomatic in early stages
• LUTS same as BPH - Frequency, Urgency, Hesitancy, Weak stream, Terminal dribbling, Nocturia
• Blood in urine/semen
• Bone and back pain (suggests metastasis)
• Erectile dsyfunction
N.B. Always ask about bone and back pain in any pt suggestive of prostate ca. to screen for metastasis
Which are the first-line investigations to do?
What other investigations should be done?
How is it managed?
➊ * DRE - firm, asymmetrical, irregular, loss of central sulcus
* Urine dip
➋ * PSA
* MRI
* Biopsy
N.B. PSA is unreliable with a high rate of false positives (75%) and false negatives (15%), therefore may lead to unnecessary further investigations or false reassurance
➌ * Active surveillance if low grade
* Radiotherapy
* Prostatectomy
* Hormonal therapy to reduce testosterone - GnRH analogues (e.g. Goserelin), GnRH antagonists, Androgen antagonists
N.B. In normal endocrine physiology, GnRH is secreted intermittently. Goserelin is a GnRH agonsit, therefore increases GnRH secretion, leading to a continual secretion and subsequently disrupting the hormonal axis. This overall results in a reduced secretion of testosterone, which reduces growth of the prostate tumour (less testosterone available to convert to DHT).
