Prostate Cancer Flashcards
What is the 10 year survival rate of Prostate Cancer?
Over 80%
What is the pathophysiology of Prostate Cancer?
Aetiology- ongoing research
Growth of prostate cancer is influenced by androgens (testosterone and dihydrotestosterone)
Majority adenocarcinoma and arise in the peripheral zone of the prostate. Often multifocal.
What are the two categories of adenocarcinomas in Prostate Cancer?
Acinar adenocarcinoma- orginates in the glandular cells that line the prostate gland. Most common form of prostate cancer.
Ductal adenocarcinoma - orginates in the cells that line the ducts of the prostate gland. Tends to grow and metastasise faster than acinar adenocarcinoma.
What are the risk factors for Prostate Cancer?
Increasing age
Ethnicity - black african or caribbean twice as likely
FH
Rarely BRAC1 OR BRAC2 gene
Modifiable risk factors - obesity, DM, smoking, degree of exercise.
What are the clincial features of Prostate Cancer?
Localised- LUTS
Advanced localised - haematuria, dysuria, incontinence, haematospermia, suprapubic pain, loin pain and even rectal tenesumus.
Meatstatic disease - bone pain, lethargy, anorexia and unexplained weight loss.
DRE - asymmetrical, nodularity or a fixed irregular mass.
What is the differential diagnosis for Prostate Cancer?
BPH
Prostatitis
Causes of haematuria: Bladder cancer, urinary stones, UTI and pyelonephritis
What investigation could intially be used in suspected Prostate Cancer?
PSA
How can PSA be artificially raised?
BPH Prostatitis Vigorous exercise Ejaculation Recent DRE
What further calculations using PSA can be done to make it more useful in Prostate Cancer?
Free:total PSA ratio - 4-10 increased chance of diagnosing prostate cancer.
PSA density - serum PSA level dividedby prostate volume which is determined by imaging (TRUS, CT or MRI) - higher the PSA density the increased likelihood of prostate cancer.
What is essential for men who are offered a PSA screening test?
Counselling prior to testing is essential
What further investigations are performed in suspected Prostate Cancer with elevated PSA?
Biopsies:
Transperineal (templete) biopsy - under GA, day case, lower risk of infection
TransRectal Ultrasound-guided (TRUS) biopsy - under LA, 12 cores are taken, 1-2% risk of sepsis
Repeat prostate biopsy after negative previous biopsy is recommended for men with rising or persistently elevatd PSA and/or suspicious DRE.
What is the grading system for Prostate Cancer?
Gleason Grading system - based upon histological appearance
TNM staging
What imaging may be done in Prostate Cancer?
Multi-parametric MRI (mp-MRI) - aid diagnosis - identify abnormal ares of prostate that can be targetted for biopsy
CT abdo-pelvis and Bone scan
What is done with all cases of Prostate Cancer?
Discussed at specialist prostate cancer MDT
Management relates risk stratification based upon PSA, gleason score and T staging
What treatment is offered to low risk disease in Prostate Cancer?
Active surveillance, radical treatment offered if show evidence of disase progression
What treatment should be offered to those at intermediate or high risk disease in Prostate Cancer?
Radical treatment options should be discussed with all men with intermediate risk disease and high risk disease with realistic disease control. Those with intermediate risk can also be offered active surveillance (should not be offered for high risk disease)
What treatment should be ofered to those who show metastaic disease in prostate cancer?
Chemotherapy agents and anti-hormonal agents can be used in metastatic prostate cancer
What treatment should be offered to those with castrate-resistant disease in prostate cancer?
Those who demonstrate evidence of hormone-relapsed disease can be considered for further chemotherapy agents, such as Docetaxel. Corticosteroids can be offered as third-line hormonal therapy after androgen deprivation therapy and anti-androgen therapy to men with hormone-relapsed prostate cancer
What is invloved in active surveillance in proatate cancer?
Active surveillance requires monitoring of patients with 3-monthly PSA, 6 month to yearly DRE, and re-biopsy at 1-3 yearly intervals assessing for progression and intervening at the appropriate time. Mp-MRI is also being used increasingly in such protocols.
What is watchful waiting in prostate cancer?
Symptom guided apporoach
What is the mainstay surgical treatment for prostate cancer?
Radical prostatectomy - open, laparoscopically or robotically
What is removed in radical prostatectomy?
Prostate gland
Seminal vesicles
Surrounding tissue
+/- pelvic lymph nodes
What are th side effects of radical prostatectomy?
ED (60-80%)
Stress incontinence
Bladder neck stenosis
What are two forms of curative radiotherapy used in localised prostate cancer?
External-beam radiotherapy - focused radiotherapy to target prostate gland and limit damge to surrounding structures
Brachytherapy- tranperineal implementation of radicoacive seeds
When is chemotherapy indicated in prostate cancer?
Metastatic prostate cancer
What are the chemothearpy options in prostate cancer?
Some examples of chemotherapy drugs used include docetaxel (recommended in men with testosterone-resistant cancer) and cabazitaxel (used with prednisolone, recommended for treating relapsed prostate cancer which has progressed after using docetaxel chemotherapy).
As prostate cancer growth is stimulated by circulating androgens (testosterone), androgen deprivation therapies are regularly used, such as via gonadotrophin-releasing hormone (GnRH) receptor agonists (e.g. goserelin)
Newer hormone therapies now exist, such as the drugs enzalutamide and abiraterone, acting to lower levels of serum testosterone. Both of these drugs are reserved for patients with metastatic prostate cancer.
