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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
What scale is used to report multiparametric MRI scan results?
5-point Likert scale
26
What multiparametric MRI scan result indicates prostate cancer?
Likert scale score > 3
27
When are prostate biopsies used to diagnose prostate cancer?
They are the second line investigation, which should be conducted following positive multiparametric MRI scan results
28
How are prostate biopsies used to diagnose prostate cancer?
They are used to determine the grade of prostate cancer
29
What is a complication that results after trans-rectal ultrasound guided prostate biopsy?
Neurosepsis
30
What are the three clincial features of neurosepsis?
Confusion Rigors Neutropenia
31
What grading system is used in prostate cancer?
Gleason Pathological Grading System
32
How do we calculate the Gleason score of prostate cancer?
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
What does a Gleason score < 6 indicate - in terms of prostate tumour grade and clincial significance?
Tumour Grade - 1 Clinical Significance - Low Grade Tumour
34
What does a Gleason score of 7 (3 + 4) indicate - in terms of prostate tumour grade and clincial significance?
Tumour Grade -2 Clinical Significance - Intermediate Grade Tumour
35
What does a Gleason score of 7 (4 + 3) indicate - in terms of prostate tumour grade and clincial significance?
Tumour Grade -3 Clinical Significance - Intermediate Grade Tumour
36
What does a Gleason score of 8 indicate - in terms of prostate tumour grade and clincial significance?
Tumour Grade - 4 Clinical Significance - High Grade Tumour
37
What does a Gleason score of 9 - 10 indicate - in terms of prostate tumour grade and clincial significance?
Tumour Grade - 5 Clinical Significance - High Grade Tumour
38
Is there a prostate cancer screening program in the UK?
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
What are the four management options of prostate cancer?
Conservative Management Radiotherapy Management Surgical Management Hormonal Management
40
When is conservative management used to treat prostate cancer?
It is used to manage localised prostate cancer (T1 - T2)
41
What is the conservative management option of prostate cancer?
Watchful waiting and active monitoring, with regular digital rectal examinations, PSA blood tests and prostate biopsies
42
What are the two radiotherapy management options of prostate cancer?
External Beam Radiotherapy Brachytherapy
43
When is external beam radiotherapy used to manage prostate cancer?
It is used to manage all prostate cancer grades
44
What is external beam radiotherapy?
It involves administration of energy beams of radiation to targeted areas within the prostate
45
When is brachytherapy used to manage localised prostate cancer?
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
What is brachytherapy?
It involves the permanent implantation of radioactive material within the prostate gland
47
What are the four complications of radiotherapy management of prostate cancer?
Proctitis Bladder Cancer Colon Cancer Rectal Cancer
48
What is the surgical management option of localised prostate cancer?
Radical Prostatectomy
49
When is radical prostatectomy used to manage prostate cancer?
It is used to manage T1-T3 prostate tumours in individuals with a life expectancy greater than 10 years
50
What is radical prostatectomy?
It It involves total removal of the prostate
51
What is a complication of radical prostatectomy?
Erectile Dysfunction
52
When are hormonal therapies used to manage prostate cancer?
They are used as an adjuvant to radiotherapy or on its own for metastatic disease
53
What are the four hormonal management options of prostate cancer?
Gonadotropin-Releasing Hormone (GnRH) Agonists Gonadotropin-Releasing Hormone (GnRH) Antagonists Androgen Receptor Antagonists Bilateral Orchidectomy
54
How are GnRH agonists used to manage prostate cancer?
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
Name a GnRH agonist used to manage prostate cancer
Goserelin
56
What drug should be administered at the of GnRH agonist treatment of prostate cancer? Why?
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
How are GnRH antagonists used to manage prostate cancer?
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
Name a GnRH antagonist used to manage prostate cancer
Degarelix
59
How are androgen receptor antagonists used to manage prostate cancer?
They block cancerous androgen receptors, leading to decreased androgen-driven malignant growth
60
Name two androgen receptor antagonists used to manage prostate cancer
Bicalutamide Flutamide
61
What is bilateral orchidectomy?
It involves bilateral removal of the testicles
62
How is bilateral orchidectomy used to manage prostate cancer?
It results in a sudden decrease in testosterone levels

Year Two - Urinary System (15 decks)

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