Prostate cancer Flashcards
What are the zones of the prostate?
- A - Fibromuscular stroma
- B - Transition zone
- C - Central zone
- D - Peripheral zone
Which zone does prostate cancer most commonly arise?
Peripheral zone
What is the most common type of carcinoma found in prostate disorder?
Adenocarcinoma
What structures can prostate cancer spread to locally?
- Seminal vesicles
- Bladder
- Rectum
Can prostate cancer spread to bone?
Yes
What is PSA?
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
What can cause an elevated PSA?
- UTI
- Chronic prostatitis
- Instrumentation (e.g. catheterisation)
- Physiological (e.g. ejaculation)
- Recent urological procedure
- BPH
- Prostate cancer
What is the upper PSA limit for those aged 50 - 60?
3.5
What is the upper age limit for those aged 60-70 years?
4.5
What is the upper PSA limit for someone over the age of 70?
6.5
What are risk factors for the development of prostate cancer?
- Age
- Race - African/Afro-carribean
- Family history
- Drugs - Finasteride/Dutasteride
- Food
How does prostatic cancer present if there was only local disease present?
Can be asymptomatic
- Weak stream
- Hesitancy
- Sensation of incomplete emptying
- Frequency
- Urgency
- Urge incontinence
- UTI
How can prostatic cancer present if there is locally invasive disease?
- Haematuria
- Perineal/suprapubic pain
- Impotence
- Incontinence
- Loin pain/anuria - obstruction
- Symptoms of renal failure
- Haemospermia
- Rectal symptoms - constipation, tenesmus, pencil thin stools
What are features of metastatic prostate cancer?
- Bone pain/sciatica
- Paraplegia - spinal cord compression
- Lymph node enlargement
- Lymphoedema - lower limbs
- Loin pain/anuria with uraemia - ureteric obstruction
- Lethargy
- Weight loss
- Cachexia
What examination would you want to do if someone presented with symptoms of prostatic disease?
Digital rectal examination
What might you find on digital rectal examination in someone with prostate cancer?
Hard, irregular mass
What investigations might you consider doing in someone with signs of prostatic cancer?
- PSA
- Transrectal ultrasound + Biopsy
- Bone scan - mets
- CT Abdo/MRI - staging
What is the gleason scoring system?
Histological grading
How is the gleason score calculated?
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
What is the gleason scoring system used for in prostate cancer?
Prognostic information
What procedure can prostate cancer be found incidentally during?
TURP
What are the stagings of Prostate Cancer?
How would you manage someone with prostate cancer with disease confined to the prostate?
Determine staging, then consider whether to take a watchful waiting/active surveillance approach, or to start treatment (surgery, irradiation, ablation)
What is involved in active surveillance?
- Monitor PSA
- DRE
- Consider Re-biopsy
What age would you consider doing a radical prostatectomy in someone with prostate cancer?
< 70 years
When would you consider active surveillance in someone with prostate cancer?
>70 and low-risk
What circumstances would a radical prostatectomy be recommended?
In those with cancer confined to the prostate - is an area for debate
What are options for the management of prostate cancer?
- Active surveillance
- Radical prostatectomy
- Radical radiotherapy
- Hormone therapy - alone or as adjuvant
- Symptomatic relief - analgesia, radiotherapy
What are the main types of hormone therapy used in prostate cancer?
- Orchidectomy
- LHRH agonist
- Diethylstilboestrol
- GNRH antagonists
- Anti-androgens
- Aromatase inhibitors
What is the basis of hormone therapy in prostate cancer?
Malignant prostate cells start off by requiring daily supply of testosterone, without which they die
What are LHRH agonists given with when treating prostate cancer?
Androgen blockers - LHRH agonists cause initial rise in testosterone before reducing it through negative feedback, causing a tumour flare unless suppressed
How does Diethystilboesterol work?
Inhibits LHRH and testosterone secrtion, inactivate androgens and has direct cytotoxic effect on prostate
What types of anti-androgens are used in prostate cancer?
- Steroids - megesterol, cyproterone
- Non-steroids - flutamide, nilutamid, bicalutamide
How do aromatase inhibitors work?
Prevent the action of aromatase, an enzyme in the prostate cell that converts adrenal steroids into testosterone
What are side effects to hormonal therapy?
- Reduced/absent libido
- Impotence
- Shrinking testicles and penis
- Hot flashes
- Breast tenderness
- Osteoporosis
- Anaemia
- Loss of muscle mass
- Weight gain
How would you symptomatically manage someone with prostate cancer?
- Analgesia
- Treat hypercalcaemia
- Radiotherapy for bone mets/spinal cord compression
What are the three components to prostate screening?
- DRE
- Transrectal US
- PSA
What factors are used to determine prognosis in someone with prostate cancer?
- Pre-Treatment PSA levels
- Tumour stage
- Tumour grade - Gleason score
What does a gleason score of 8-10 indicate?
Aggressive disease
What does a gleason score of 5-7 indicate?
Intermediate disease
What does a gleason score of 2-4 indicate?
Indolent disease
