prostate cancer Flashcards
What are prostate cancers?
Most prostate cancers are adenocarcinomas arising in the peripheral zone of the prostate gland. Most prostate cancers are slow-growing but some prostate cancers are aggressive.
Where does prostate cancer easily metastasise to?
Bone and lymph
What is the incidence for prostate cancer?
What is the most common age?
About 1 in 8 men will get prostate cancer at some point in their life
Incidence rates for prostate cancer in the UK are highest in males aged 75 to 79.
What are the most common risk factors for prostate cancer?
- Age
- Ethnicity (Prostate cancer is most common in black males, then white males, and is least common in Asian males)
- Genetic predisposition (If one first-degree relative has prostate cancer, the risk is at least doubled)
What is prostate specific antigen (PSA)?
Prostate specific antigen (PSA) is a protease whose function is to break down the high molecular weight protein of the seminal coagulum into smaller polypeptides.
This action results in the semen becoming more liquid
Serum prostate specific antigen is currently the best method of detecting localised prostatic cancer and monitoring response to treatment but it lacks specificity, as it is also increased in most patients with benign prostatic hyperplasia
what percentage of people with a raised PSA will have prostate cancer?
25%
What are the symptoms of local prostate cancer?
Raised PSA on screening.
Weak stream, hesitancy, sensation of incomplete emptying, urinary frequency, urgency, urge incontinence
What are the symptoms of local invasive prostate cancer?
Haematuria, dysuria, incontinence. Haematospermia. Perineal and suprapubic pain. Obstruction of ureters, causing loin pain, anuria, symptoms of acute kidney injury or chronic kidney disease. Impotence. Rectal symptoms - eg, tenesmus.
What are the symptoms of metastatic prostate cancer?
Bone pain or sciatica.
Paraplegia secondary to spinal cord compression.
Lymph node enlargement.
Loin pain or anuria due to ureteric obstruction by lymph nodes.
Lethargy (anaemia, uraemia).
Weight loss, cachexia.
What are the signs of prostate cancer?
Advanced disease: general malaise, bone pain, anorexia, weight loss, obstructive nephropathy, paralysis due to cord compression.
Abdominal palpation may demonstrate a palpable bladder due to outflow obstruction.
Digital rectal examination (DRE) may reveal a hard, irregular prostate gland.
What investigations would you do in suspected prostate cancer?
- Urinalysis
- Renal function test
- Prostate biopsy
- MRI
How is prostate cancer classified?
Non-metastatic: either localised disease confined to the prostate gland or locally advanced disease that has spread outside the capsule of the gland but has not spread to organs, other than the seminal vesicles.
Metastatic: spread beyond the prostate to local, regional, or systemic lymph nodes, or to other body organs - eg, bone, liver, or brain.
What is the Gleason grading system?
What are the grades?
Histological grading system for prostate cancer
Grade 1: small, uniform glands with minimal nuclear changes.
Grade 2: medium-sized acinii, separated by stromal tissue but more closely arranged.
Grade 3: marked variation in glandular size and organisation and infiltration of stromal and neighbouring tissues.
Grade 4: marked atypical cytology with extensive infiltration.
Grade 5: sheets of undifferentiated cells.
How is the result of Gleaon score used?
Prostate cancers are often heterogeneous and the Gleason score is the sum of the two most prominent grades.
Gleason score of 4 or less: well differentiated; ten-year risk of local progression 25%.
Gleason score 5-7: moderately differentiated; ten-year risk of local progression 50%.
Gleason score over 7: poorly differentiated; ten-year risk of local progression 75%.
How would you manage prostate cancer?
Active surveillance
Surgery (radical prostatectomy)
Radiotherapy
Androgen deprivation treatment
Cryotherapy
