Prostate Cancer Flashcards
where does prostate cancer spread?
inguinal lymph nodes?
bone
prostate cancer is dependent on what to grow?
androgen hormones (testosterone)
prostate cancer is generally what type?
adenocarcinoma
where does prostate cancer generally arise?
peripheral zone of prostate
main risk factors for prostate cancer?
age fam history african/caribbean origin tall stature anabolic steroids
how does prostate cancer present?
can be asymptomatic
can cause lower urinary tract symptoms (hesitancy, frequency, weak flow, terminal dribbling and nocturia)
haematuria
why does prostate cancer not cause weak flow, retention etc as much as benign prostatic hypertrophy?
as benign prostatic hypertrophy arises in central zone to presses on urethra
cancer usually in peripheral zone so doesnt press on urethra as much
other possible features of prostate cancer?
Erectile dysfunction
symptoms of advanced disease or metastasis (weight loss, bone pain etc)
what is PSA?
prostate specific antigen
glycoprotein produced by epithelial cells of the prostate and secreted into semen with a small amount entering the blood
helps thin out semen into a liquid consistency after ejaculation
how is PSA used?
mainly used to check for response to treatment and screen for recurrence of prostate cancer
too high a false positive rate to be really useful in diagnosis as so many things can cause raised PSA
what can cause raised PSA?
BPH prostate cancer prostatitis UTI vigorous exercise (esp cycling) recent ejaculation or prostate stimulation
how does benign prostate feel on examination?
smooth symmetrical slightly soft maintained central sulcus (dip between lobes) may have generalized enlargement in BPH
how does infected/inflamed prostate feel on examination?
enlarged
tender
warm
what does prostate cancer feel like on examination?
firm/hard asymmetrical craggy or irregular loss of central sulcus can have a hard nodule
if any features suggestive of cancer are found on examination, what is done?
urgent referral (2 week wait rule) to urology
first line investigation in suspected prostate cancer?
multiparameteric MRI
how is MRI used?
results reported on linkert scale 1 = very low chance 2 = low chance 3 = equivocal 4 = probably cancer 5 = definite cancer
next step in diagnosis after MRI?
prostate biopsy (done if linkert score 3 or above)
how is prostate biopsy done?
multiple needles used to take multiple biopsies of different areas of the prostate (incase the cancer is missed giving a false positive)
can be guided by MRI results
2 types of prostate biopsy?
transrectal US guided biopsy (TRUS)
transperineal biopsy
main risks of prostate biopsy?
pain
bleeding (can be seen in stool, urine or semen)
infection
urinary retention (due to short term swelling of prostate)
erectile dysfunction (rare)
how is biopsy result used?
histology result used to grade cancer via gleason system
the greater the score, the more poorly differentiated the tumour is and the worse the prognosis is
describe gleason grading?
rissue samples from biopsy graded from 1 (closest to normal) to 5 (most abnormal)
score made up of 2 numbers added together
- grade of the most prevalent pattern in the biopsy
+
- grade of second most prevalent pattern in biopsy
score of 6 = low risk
7 = intermediate risk
8+ = high risk
how is prostate cancer staged?
TNM
how is metastases screened for in prostate cancer?
isotope bone scan (AKA radionucleotide scan or bone scintigrophy) used to check for bone mets
possible management options for prostate cancer?
watchful waiting external beam radiotherapy brachytherapy hormone therapy surgery
key complication of external beam radiotherapy in prostate cancer?
proctitis (inflammation of the rectum)
can result in pain, altered bowel habit, bleeding and discharge
prednisolone suppository can help
how is hormone therapy used in prostate cancer?
aims to reduce level of androgens (testosterone)
usually used in combination with radiotherapy or alone in advanced disease where cure not possible
types of hormonal therapy?
androgen-receptor blockers (eg bicalutamide) GnRH agonists (eg goserelin or leuprorelin) bilateral orchidectomy (removal of testicles - rarely done)
side effects of hormone therapy?
hot flushes sexual dysfunction gynaecomastia fatigue osteoporosis
