Prostate Cancer Flashcards
What is prostate cancer?
It is defined as the proliferation of malignant cells within the prostate
What is the most common classification of prostate cancer?
Adenocarcinoma
In which zone of the prostate, does prostate cancer most commonly occur?
Peripheral Zone
What four risk factors are associated with prostate cancer?
Older Age > 50
Black Ethnicity
Family History
Obesity
In most cases, how does prostate cancer tend to present?
Asymptomatically
Therefore, it is usually diagnosed through screening
What are the ten clinical features of prostate cancer?
Polyuria
Nocturia
Dysuria
Urinary Urgency
Urinary Hesitancy
Post-Void Dribbling
Haematuria
Haematospermia
Bone Pain
Weight Loss
What four investigations are used to diagnose prostate cancer?
Digital Rectal Examination
Prostate Specific Antigen (PSA) Blood Test
Multiparametric MRI Scans
Prostate Biopsy
What are the two features of prostate cancer on digital rectal examination?
Asymmetrical Hard Nodular Prostate Enlargement
Median Sulcus Loss
When are PSA blood tests used to diagnose prostate cancer?
It is the first line investigation of prostate cancer
What is PSA?
It is a serine protease enzyme produced by prostate epithelial cells
What is the function of PSA?
It is a protein which liquefies semen
In 50 - 59 year olds, what PSA level is deemed elevated?
> 3
In 60 - 69 year olds, what PSA level is deemed elevated?
> 4
In > 70 year olds, what PSA level is deemed elevated?
> 5
What are the three criteria for an urgent two week urologist referral of prostate cancer?
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
In addition to prostate cancer, what are the nine other causes of an elevated PSA level?
Benign Prostatic Hyperplasia
Prostatitis
Prostate Biopsy
Digitial Rectal Examination
Urinary Tract Infection
Urinary Retention
Urinarty Tract Instrumentation
Ejaculation
Vigorous Exercise
How long following prostatitis should PSA blood tests be postponed?
4 weeks
How long following a prostate biopsy should PSA blood tests be postponed?
6 weeks
How long following a digital rectal exam should PSA blood tests be postponed?
1 week
How long following a urinary tract infection should PSA blood tests be postponed?
4 weeks
How long following ejaculation should PSA blood tests be postponed?
48 hours
How long following vigorous exercise should PSA blood tests be postponed?
48 hours
When are multiparametric MRI scans used to diagnnose prostate cancer?
They are the first line investigation, which should be conducted following an abnormal digital rectal examination or PSA blood test
What is a multiparametric MRI scan?
It involves conduction of a specialised MRI scan, which produces a detailed image of the prostate gland
What scale is used to report multiparametric MRI scan results?
5-point Likert scale
What multiparametric MRI scan result indicates prostate cancer?
Likert scale score > 3
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
How are prostate biopsies used to diagnose prostate cancer?
They are used to determine the grade of prostate cancer
What is a complication that results after trans-rectal ultrasound guided prostate biopsy?
Neurosepsis
What are the three clincial features of neurosepsis?
Confusion
Rigors
Neutropenia
What grading system is used in prostate cancer?
Gleason Pathological Grading System
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
What does a Gleason score < 6 indicate - in terms of prostate tumour grade and clincial significance?
Tumour Grade - 1
Clinical Significance - Low Grade Tumour
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
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
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
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
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
What are the four management options of prostate cancer?
Conservative Management
Radiotherapy Management
Surgical Management
Hormonal Management
When is conservative management used to treat prostate cancer?
It is used to manage localised prostate cancer (T1 - T2)
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
What are the two radiotherapy management options of prostate cancer?
External Beam Radiotherapy
Brachytherapy
When is external beam radiotherapy used to manage prostate cancer?
It is used to manage all prostate cancer grades
What is external beam radiotherapy?
It involves administration of energy beams of radiation to targeted areas within the prostate
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
What is brachytherapy?
It involves the permanent implantation of radioactive material within the prostate gland
What are the four complications of radiotherapy management of prostate cancer?
Proctitis
Bladder Cancer
Colon Cancer
Rectal Cancer
What is the surgical management option of localised prostate cancer?
Radical Prostatectomy
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
What is radical prostatectomy?
It It involves total removal of the prostate
What is a complication of radical prostatectomy?
Erectile Dysfunction
When are hormonal therapies used to manage prostate cancer?
They are used as an adjuvant to radiotherapy or on its own for metastatic disease
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
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
Name a GnRH agonist used to manage prostate cancer
Goserelin
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
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
Name a GnRH antagonist used to manage prostate cancer
Degarelix
How are androgen receptor antagonists used to manage prostate cancer?
They block cancerous androgen receptors, leading to decreased androgen-driven malignant growth
Name two androgen receptor antagonists used to manage prostate cancer
Bicalutamide
Flutamide
What is bilateral orchidectomy?
It involves bilateral removal of the testicles
How is bilateral orchidectomy used to manage prostate cancer?
It results in a sudden decrease in testosterone levels
