Prostate Cancer Flashcards
EPIDEMIOLOGY
Where does rank in most common cancers in men
Most common cancer in men
Fast or slow growing
Often very slow growing and do not cause death
Hormonal dependent?
Almost always androgen dependent, relying on androgen hormones (eg testosterone) to grow
Histological classification and where on prostate
Majority are adenocarcinomas
Grow in peripheral zone of prostate
AETIOLOGY
Risk factors
- Increasing age
- FH
- Black african or caribbean origin
- Tall stature
- Anabolic steroids
CLINICAL FEATURES
Presentation
- May be asymptomatic
- May present with lower urinary tract symptoms, similar to BPH
- Hesitancy
- Frequency
- Weak flow
- Terminal dribbling
- Nocturia
- Haematuria
- Erectile dysfunction
- Symptoms of advance disease or metastasis
- Weight loss
- Bone pain
- Cauda equina syndrome
CLINICAL FEATURES
Prostate examination findings
- Firm or hard
- Asymmetrical or irregular
- Loss of central sulcas
- Hard nodule
Prostate exam findings for infected prostate
Enlarged, tender and warm
Prostate exam findings for benign prostate
- Smooth, symmetrical and slightly soft
- Central sulcus present
- May be generalised enlargement in prostatic hyperplasia
INVESTIGATIONS
First choice
- Serum prostate-specific antigen (PSA)
- Multiparametric MRI
- Prostate biopsy - establish diagnosis
- Isotope bone scan - bony metastasis
Problems with PSA test
High rate of false positives (75%) and false negatives (15%)
Common causes of raised PSA
- Prostate cancer
- Benign prostatic hyperplasia
- Prostitis
- UTI
- Vigorous exercise
- Recent ejaculation or prostate stimulation
How are results of multiparametric MRI displayed
- Likert scale
- 1 - very low suspicion
- 2 - low suspicion
- 3 - equivocal
- 4 - probable cancer
- 5 - definite cancer
INVESTIGATIONS
Options for prostate biopsy
- Transrectal ultrasound guided biopsy (TRUS)
- Transperineal biopsy
Risks of prostate biopsy
- Pain
- Bleeding
- Infection
- Urinary retention
- Erectile dysfunction
What grading system is used in prostate cancer
Gleason grading system and TNM staging
Describe Gleason grading system
- Based on histology from prostate biopsies
- Graded 1 (closest to normal) to 5 (most abnormal)
- Made up of 2 numbers added together for final score
- First number is grade of most prevalent pattern in biopsy
- Second is grade of second most prevalent pattern in biopsy
What does each Gleason score mean
- 6 low risk
- 7 intermediate risk
- >=8 high risk
Describe TNM staging for prostate cancer
- T for tumour
- Tx - unable to assess size
- T1 - too small to be felt on examination
- T2 - contained within prostate
- T3 - extends out of prostate
- T4 - spread to nearby organs
- N for nodes
- Nx - unable to assess
- N0 - no nodal spread
- N1 - spread to lymph nodes
- M for metastasis
- M0 - none
- M1 - metastasis
MANAGEMENT
General principles
- Suveillance (in early)
- External beam radiotherapy
- Brachytherapy
- Hormone therapy
- Surgery
MANAGEMENT
Key complication of external beam radiotherapy
- Proctitis
- Inflammation of rectum
- Causing pain, altered bowel habit, rectal bleeding and discharge
What can be used to help proctitis complication
Prednisolone suppositories - reduce inflammation
What is brachytherapy
Implanting radioactive metal ‘seeds’ into prostate, delivering continuous, targeted radiotherapy to prostate
Side effects of brachytherapy
- Inflammation to nearby organs (cystitis, proctitis)
- Erectile dysfunction
- Incontinence
- Increased risk bladder or rectal cancer
MANAGEMENT
Hormonal therapy options
- Androgen-receptor blockers (eg bicalutamide)
- GnRH agonist (eg goserelin or leuproelin)
- Bilateral orchidectomy
Side effects of hormonal therapy
- Hot flushes
- Sexual dysfunction
- Gynaemocastia
- Fatigue
- Osteoporosis
