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Renal and Urology > Prostate cancer > Flashcards

Prostate cancer Flashcards

1
Q

What are the zones of the prostate?

A
  • A - Fibromuscular stroma
  • B - Transition zone
  • C - Central zone
  • D - Peripheral zone
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2
Q

Which zone does prostate cancer most commonly arise?

A

Peripheral zone

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3
Q

What is the most common type of carcinoma found in prostate disorder?

A

Adenocarcinoma

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4
Q

What structures can prostate cancer spread to locally?

A
  • Seminal vesicles
  • Bladder
  • Rectum
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5
Q

Can prostate cancer spread to bone?

A

Yes

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6
Q

What is PSA?

A

Androgen regulated protease secreted only by prostatic cells whether benign or malignant. It liquefies semen through its action on gel-forming proteins within the semen following ejaculation. It spills into the bloodstream where it can be measured

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7
Q

What can cause an elevated PSA?

A
  • UTI
  • Chronic prostatitis
  • Instrumentation (e.g. catheterisation)
  • Physiological (e.g. ejaculation)
  • Recent urological procedure
  • BPH
  • Prostate cancer
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8
Q

What is the upper PSA limit for those aged 50 - 60?

A

3.5

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9
Q

What is the upper age limit for those aged 60-70 years?

A

4.5

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10
Q

What is the upper PSA limit for someone over the age of 70?

A

6.5

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11
Q

What are risk factors for the development of prostate cancer?

A
  • Age
  • Race - African/Afro-carribean
  • Family history
  • Drugs - Finasteride/Dutasteride
  • Food
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12
Q

How does prostatic cancer present if there was only local disease present?

A

Can be asymptomatic

  • Weak stream
  • Hesitancy
  • Sensation of incomplete emptying
  • Frequency
  • Urgency
  • Urge incontinence
  • UTI
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13
Q

How can prostatic cancer present if there is locally invasive disease?

A
  • Haematuria
  • Perineal/suprapubic pain
  • Impotence
  • Incontinence
  • Loin pain/anuria - obstruction
  • Symptoms of renal failure
  • Haemospermia
  • Rectal symptoms - constipation, tenesmus, pencil thin stools
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14
Q

What are features of metastatic prostate cancer?

A
  • Bone pain/sciatica
  • Paraplegia - spinal cord compression
  • Lymph node enlargement
  • Lymphoedema - lower limbs
  • Loin pain/anuria with uraemia - ureteric obstruction
  • Lethargy
  • Weight loss
  • Cachexia
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15
Q

What examination would you want to do if someone presented with symptoms of prostatic disease?

A

Digital rectal examination

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16
Q

What might you find on digital rectal examination in someone with prostate cancer?

A

Hard, irregular mass

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17
Q

What investigations might you consider doing in someone with signs of prostatic cancer?

A
  • PSA
  • Transrectal ultrasound + Biopsy
  • Bone scan - mets
  • CT Abdo/MRI - staging
18
Q

What is the gleason scoring system?

A

Histological grading

19
Q

How is the gleason score calculated?

A

Grades are decided by sampling 2 different areas of the tumour specimen, and histologically grading them in terms of differentiation from 1-5. The grades for each specimen are then added together to give a score out of 10

20
Q

What is the gleason scoring system used for in prostate cancer?

A

Prognostic information

21
Q

What procedure can prostate cancer be found incidentally during?

A

TURP

22
Q

What are the stagings of Prostate Cancer?

A
23
Q

How would you manage someone with prostate cancer with disease confined to the prostate?

A

Determine staging, then consider whether to take a watchful waiting/active surveillance approach, or to start treatment (surgery, irradiation, ablation)

24
Q

What is involved in active surveillance?

A
  • Monitor PSA
  • DRE
  • Consider Re-biopsy
25
Q

What age would you consider doing a radical prostatectomy in someone with prostate cancer?

A

< 70 years

26
Q

When would you consider active surveillance in someone with prostate cancer?

A

>70 and low-risk

27
Q

What circumstances would a radical prostatectomy be recommended?

A

In those with cancer confined to the prostate - is an area for debate

28
Q

What are options for the management of prostate cancer?

A
  • Active surveillance
  • Radical prostatectomy
  • Radical radiotherapy
  • Hormone therapy - alone or as adjuvant
  • Symptomatic relief - analgesia, radiotherapy
29
Q

What are the main types of hormone therapy used in prostate cancer?

A
  • Orchidectomy
  • LHRH agonist
  • Diethylstilboestrol
  • GNRH antagonists
  • Anti-androgens
  • Aromatase inhibitors
30
Q

What is the basis of hormone therapy in prostate cancer?

A

Malignant prostate cells start off by requiring daily supply of testosterone, without which they die

31
Q

What are LHRH agonists given with when treating prostate cancer?

A

Androgen blockers - LHRH agonists cause initial rise in testosterone before reducing it through negative feedback, causing a tumour flare unless suppressed

32
Q

How does Diethystilboesterol work?

A

Inhibits LHRH and testosterone secrtion, inactivate androgens and has direct cytotoxic effect on prostate

33
Q

What types of anti-androgens are used in prostate cancer?

A
  • Steroids - megesterol, cyproterone
  • Non-steroids - flutamide, nilutamid, bicalutamide
34
Q

How do aromatase inhibitors work?

A

Prevent the action of aromatase, an enzyme in the prostate cell that converts adrenal steroids into testosterone

35
Q

What are side effects to hormonal therapy?

A
  • Reduced/absent libido
  • Impotence
  • Shrinking testicles and penis
  • Hot flashes
  • Breast tenderness
  • Osteoporosis
  • Anaemia
  • Loss of muscle mass
  • Weight gain
36
Q

How would you symptomatically manage someone with prostate cancer?

A
  • Analgesia
  • Treat hypercalcaemia
  • Radiotherapy for bone mets/spinal cord compression
37
Q

What are the three components to prostate screening?

A
  • DRE
  • Transrectal US
  • PSA
38
Q

What factors are used to determine prognosis in someone with prostate cancer?

A
  • Pre-Treatment PSA levels
  • Tumour stage
  • Tumour grade - Gleason score
39
Q

What does a gleason score of 8-10 indicate?

A

Aggressive disease

40
Q

What does a gleason score of 5-7 indicate?

A

Intermediate disease

41
Q

What does a gleason score of 2-4 indicate?

A

Indolent disease

Renal and Urology (51 decks)

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