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Year Two - Urinary System > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

What is prostate cancer?

A

It is defined as the proliferation of malignant cells within the prostate

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2
Q

What is the most common classification of prostate cancer?

A

Adenocarcinoma

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3
Q

In which zone of the prostate, does prostate cancer most commonly occur?

A

Peripheral Zone

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4
Q

What four risk factors are associated with prostate cancer?

A

Older Age > 50

Black Ethnicity

Family History

Obesity

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5
Q

In most cases, how does prostate cancer tend to present?

A

Asymptomatically

Therefore, it is usually diagnosed through screening

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6
Q

What are the ten clinical features of prostate cancer?

A

Polyuria

Nocturia

Dysuria

Urinary Urgency

Urinary Hesitancy

Post-Void Dribbling

Haematuria

Haematospermia

Bone Pain

Weight Loss

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7
Q

What four investigations are used to diagnose prostate cancer?

A

Digital Rectal Examination

Prostate Specific Antigen (PSA) Blood Test

Multiparametric MRI Scans

Prostate Biopsy

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8
Q

What are the two features of prostate cancer on digital rectal examination?

A

Asymmetrical Hard Nodular Prostate Enlargement

Median Sulcus Loss

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9
Q

When are PSA blood tests used to diagnose prostate cancer?

A

It is the first line investigation of prostate cancer

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10
Q

What is PSA?

A

It is a serine protease enzyme produced by prostate epithelial cells

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11
Q

What is the function of PSA?

A

It is a protein which liquefies semen

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12
Q

In 50 - 59 year olds, what PSA level is deemed elevated?

A

> 3

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13
Q

In 60 - 69 year olds, what PSA level is deemed elevated?

A

> 4

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14
Q

In > 70 year olds, what PSA level is deemed elevated?

A

> 5

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15
Q

What are the three criteria for an urgent two week urologist referral of prostate cancer?

A

Male 50 – 69 Years Old, PSA > 3ng/ml

Male > 70 Years Old, PSA > 5ng/ml

It is recommended in the context of a suspicious digitial rectal examination, irrespective of a patients PSA

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16
Q

In addition to prostate cancer, what are the nine other causes of an elevated PSA level?

A

Benign Prostatic Hyperplasia

Prostatitis

Prostate Biopsy

Digitial Rectal Examination

Urinary Tract Infection

Urinary Retention

Urinarty Tract Instrumentation

Ejaculation

Vigorous Exercise

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17
Q

How long following prostatitis should PSA blood tests be postponed?

A

4 weeks

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18
Q

How long following a prostate biopsy should PSA blood tests be postponed?

A

6 weeks

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19
Q

How long following a digital rectal exam should PSA blood tests be postponed?

A

1 week

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20
Q

How long following a urinary tract infection should PSA blood tests be postponed?

A

4 weeks

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21
Q

How long following ejaculation should PSA blood tests be postponed?

A

48 hours

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22
Q

How long following vigorous exercise should PSA blood tests be postponed?

A

48 hours

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23
Q

When are multiparametric MRI scans used to diagnnose prostate cancer?

A

They are the first line investigation, which should be conducted following an abnormal digital rectal examination or PSA blood test

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24
Q

What is a multiparametric MRI scan?

A

It involves conduction of a specialised MRI scan, which produces a detailed image of the prostate gland

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25
Q

What scale is used to report multiparametric MRI scan results?

A

5-point Likert scale

26
Q

What multiparametric MRI scan result indicates prostate cancer?

A

Likert scale score > 3

27
Q

When are prostate biopsies used to diagnose prostate cancer?

A

They are the second line investigation, which should be conducted following positive multiparametric MRI scan results

28
Q

How are prostate biopsies used to diagnose prostate cancer?

A

They are used to determine the grade of prostate cancer

29
Q

What is a complication that results after trans-rectal ultrasound guided prostate biopsy?

A

Neurosepsis

30
Q

What are the three clincial features of neurosepsis?

A

Confusion

Rigors

Neutropenia

31
Q

What grading system is used in prostate cancer?

A

Gleason Pathological Grading System

32
Q

How do we calculate the Gleason score of prostate cancer?

A

It involves pathological assessment of the prostate biopsy sample, in which the two most prevalent differentiation patterns are identified and assigned a Gleason grade – ranging from 3, well differentiated, to 5, poorly differentiated

In order to determine the Gleason score, we add the two grades together

33
Q

What does a Gleason score < 6 indicate - in terms of prostate tumour grade and clincial significance?

A

Tumour Grade - 1

Clinical Significance - Low Grade Tumour

34
Q

What does a Gleason score of 7 (3 + 4) indicate - in terms of prostate tumour grade and clincial significance?

A

Tumour Grade -2

Clinical Significance - Intermediate Grade Tumour

35
Q

What does a Gleason score of 7 (4 + 3) indicate - in terms of prostate tumour grade and clincial significance?

A

Tumour Grade -3

Clinical Significance - Intermediate Grade Tumour

36
Q

What does a Gleason score of 8 indicate - in terms of prostate tumour grade and clincial significance?

A

Tumour Grade - 4

Clinical Significance - High Grade Tumour

37
Q

What does a Gleason score of 9 - 10 indicate - in terms of prostate tumour grade and clincial significance?

A

Tumour Grade - 5

Clinical Significance - High Grade Tumour

38
Q

Is there a prostate cancer screening program in the UK?

A

There is no formal screening program for prostate cancer

However, males over the age of 50 are eligible to request a PSA test, following discussions with their GP about the pros and cons

39
Q

What are the four management options of prostate cancer?

A

Conservative Management

Radiotherapy Management

Surgical Management

Hormonal Management

40
Q

When is conservative management used to treat prostate cancer?

A

It is used to manage localised prostate cancer (T1 - T2)

41
Q

What is the conservative management option of prostate cancer?

A

Watchful waiting and active monitoring, with regular digital rectal examinations, PSA blood tests and prostate biopsies

42
Q

What are the two radiotherapy management options of prostate cancer?

A

External Beam Radiotherapy

Brachytherapy

43
Q

When is external beam radiotherapy used to manage prostate cancer?

A

It is used to manage all prostate cancer grades

44
Q

What is external beam radiotherapy?

A

It involves administration of energy beams of radiation to targeted areas within the prostate

45
Q

When is brachytherapy used to manage localised prostate cancer?

A

It is is used to manage T1 – T2 localised prostate tumours, in which individuals have a Gleason score of 7, PSA level < 20ng/ml and a life expectancy greater than 5 years

46
Q

What is brachytherapy?

A

It involves the permanent implantation of radioactive material within the prostate gland

47
Q

What are the four complications of radiotherapy management of prostate cancer?

A

Proctitis

Bladder Cancer

Colon Cancer

Rectal Cancer

48
Q

What is the surgical management option of localised prostate cancer?

A

Radical Prostatectomy

49
Q

When is radical prostatectomy used to manage prostate cancer?

A

It is used to manage T1-T3 prostate tumours in individuals with a life expectancy greater than 10 years

50
Q

What is radical prostatectomy?

A

It It involves total removal of the prostate

51
Q

What is a complication of radical prostatectomy?

A

Erectile Dysfunction

52
Q

When are hormonal therapies used to manage prostate cancer?

A

They are used as an adjuvant to radiotherapy or on its own for metastatic disease

53
Q

What are the four hormonal management options of prostate cancer?

A

Gonadotropin-Releasing Hormone (GnRH) Agonists

Gonadotropin-Releasing Hormone (GnRH) Antagonists

Androgen Receptor Antagonists

Bilateral Orchidectomy

54
Q

How are GnRH agonists used to manage prostate cancer?

A

They result in activation of GnRH receptors, however when administered over a prolonged period of time, lead to desensitisation and decreased androgen secretion

Ultimately, this leads to decreased testosterone levels, which results in shrinkage of the prostate gland and the associated malignancy

55
Q

Name a GnRH agonist used to manage prostate cancer

A

Goserelin

56
Q

What drug should be administered at the of GnRH agonist treatment of prostate cancer? Why?

A

Anti-androgen drugs - such as bicalutamide, flutamide and cyproterone acetate

This is to prevent the initial rise in testosterone levels, which can lead to a tumour flare and clinical features, such as bone pain, bladder obstruction, etc

57
Q

How are GnRH antagonists used to manage prostate cancer?

A

They competitively bind to GnRH receptors

Ultimately, this leads to decreased testosterone levels, which results in shrinkage of the prostate gland and the associated malignancy

58
Q

Name a GnRH antagonist used to manage prostate cancer

A

Degarelix

59
Q

How are androgen receptor antagonists used to manage prostate cancer?

A

They block cancerous androgen receptors, leading to decreased androgen-driven malignant growth

60
Q

Name two androgen receptor antagonists used to manage prostate cancer

A

Bicalutamide

Flutamide

61
Q

What is bilateral orchidectomy?

A

It involves bilateral removal of the testicles

62
Q

How is bilateral orchidectomy used to manage prostate cancer?

A

It results in a sudden decrease in testosterone levels

Year Two - Urinary System (15 decks)

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