Prostate cancer Flashcards
What are the main risk factors of prostate cancer?
increasing age
obesity
Afro-Caribbean ethnicity
family history: around 5-10% of cases have a strong family history
What genes in the family history are associated with an increased risk of prostate cancer?
HCP1, BRCA1 and BRCA2 gene
What are the different ways that prostate cancer can present?
Asymptomatic
Local
Advanced
What would you find if the prostate cancer was asymptomatic?
Abnormal digital rectal examination
Raised PSA
What would you find if the prostate cancer was local?
Haematuria
Haematospermia
Benign outflow obstruction
What would find if the prostate cancer was advanced?
Lymphadenopathy
Spinal cord compression
What is the triad that is used for the diagnosis of prostate cancer?
Raised PSA
Abnormal DRE
TRUS guided biopsy
What is now the first line investigation of someone suspected of having localised prostate cancer?
Multiparametric MRI
What is PSA used for?
To monitor the progression of the disease
Before you take PSA, what should the man abstain from doing?
Ejaculation or vigorous exercise for 48 hours
Where does prostate cancer metastasise to?
- Lymph nodes
* Bone, lung and viscera
How is prostate cancer graded?
The Gleason Grading score
What does a high grade suggest?
The worse the prognosis
What is the management of localised prostate cancer (T1/T2)?
conservative: active monitoring & watchful waiting
radical prostatectomy
radiotherapy: external beam and brachytherapy
What is the management of localised prostate cancer?
conservative: active monitoring & watchful waiting
radical prostatectomy
radiotherapy: external beam and brachytherapy
What is the management of localised advanced prostate cancer (T3/T4)?
hormonal therapy: Goserelin
radical prostatectomy
radiotherapy- external beam and brachytherapy
What is the management of metastatic prostate cancer?
Hormonal therapy
Chemical castration: Goserelin (GnRH agonist)
What is a possible compilation of radical prostatectomy? (removal of the prostate)
Erectile dysfunction
Urinary incontinence
What are other possible cause of raised PSA?
Acute urinary retention
Benign prostatic hyperplasia
Prostatitis
Urinary tract infections
Vigorous exercise
How would a cancerous prostate feel on DRE?
Firm or hard, asymmetrical, craggy or irregular, with loss of the central sulcus.
What are the results of a multiparametic MRI reported on
Likert scale
What number on the likert scale would indicate that a biopsy should be carried out?
3 and above
What are the main complications of radical prostatectomy?
Erectile dysfunction
Urinary incontinence.
What are the possible side effects of hormonal therapy?
Decreased labido
Impotence
Infertility
Gynecomastia
Osteoporosis
What type of cancer does prostate cancer tend to be?
Adenocarcinoma
The use of which drugs increases the risk of prostate cancer?
The use of anabolic steroids
What type of drug is Goserelin?
GnRH agonist
What are possible complications of radiotherapy?
increased risk of bladder, colon and rectal cancer
What can Goserelin cause initially?
Transient increase in symptoms of prostatic cancer- The ‘flare effect’ and is caused by an initial increase in luteinizing hormone production prior to receptor down-regulation.
What can be given to avoid the flare effect from goserelin?
Pre-treatment with Flutamide
What is flutamide?
A synthetic antiandrogen
What medication do you give along with goserelin?
cyproterone acetate
What is the function of cyproterone acetate?
Prevent paradoxical increase in symptoms with GnRH agonists
