Prostate Cancer Flashcards
Prostate cancer
- Adenocarcinoma
* Peripheral zone of prostate - can be palpated
Presentation of prostate cancer
- Usually asymptomatic
- Urinary: nocturia, frequency, hesitancy, poor stream, terminal dribbling, obstruction
- Systemic: wt. loss, fatigue
- Mets: bone pain
Examination of prostate cancer
- Hard irregular prostate on PR
* Loss of midline sulcus
Spread of prostate cancer
- Local: seminal vesicles, bladder, rectum
- Lymph: para-aortic nodes
- Haem: sclerotic bony lesions
Ix of prostate Ca
- Bloods: PSA before PR, U+E, ALP, Ca
- DRE
- multiparametric MRI - if high PSA + DRE signs to avoid over diagnosis and treatment (triage)
• Transperineal (Template) biopsy
Or
• Transrectal US + biopsy
• Imaging
- XR chest and spine
- Bone scan
- Staging CT
PSA
• Not specific for prostate Ca
Increased with:
- Age
- PR
- TURP
- prostatitis
- Cycling
- BPH
Grading system
Gleason Grade
- Score two worst affected areas
- Lowest score (best) - 6
- Highest score (worse) - 10
Mx of prostate cancer
- Conservative: watchful waiting or active surveillance
- Radical prostatectomy if <75yo
- Brachytherapy: implantation of palladium seeds
- Radiotherapy - bone mets
- Chemotherapy agents and anti-hormonal agents - mets
- TURP - obstruction
- androgen deprivation therapy - GnRH receptor agonists e.g. goserelin
Risk factors for prostate cancer
Age
Afro Caribbean
FHx
BRCA 1/2
Obesity
Smoking
DM
Watchful Waiting
Normally for older patients
Symptom-guided approach:
- hormonal therapy is initiated at time of symptomatic disease
Active surveillance
Low-risk disease
Requires:
- 3-monthly PSA
- 6 month to yearly DRE
- Re-biopsy every 1-3 yearly
Assessing:
- progression and intervening at the appropriate time.
Radical prostatectomy
Removal of:
- prostate gland
- resection of the seminal vesicles
with the surrounding tissue +/- dissection of the pelvic lymph nodes
Side effects of radical prostatectomy
- Erectile dysfunction
- Stress incontinence
- Bladder neck stenosis
