Prostate Cancer Flashcards
What type of cancer is prostate cancer most commonly?
Where are prostate cancers most commonly located?
Adenocarcinoma
Grow in peripheral zone of the prostate
What do most prostate cancers rely on for growth?
Most are androgen-dependent meaning they require testosterone to grow
Where is prostate cancer most likely to metastasise to?
Lymph nodes and bones
I.e. LUMBAR SPINE MOST COMMONLY
What are the risk factors for developing prostate cancer?
Increasing age
Family history
Black african or caribbean origin
Tall stature
Anabolic steroids
How might someone with local prostate cancer present?
Present with lower urinary tracy symptoms (LUTS): i.e. symptoms very similar to BPH due to tumour causing narrowing of the urethra
- hesistancy
- freqeuncy
- weak flow
- terminal dribbling
- nocturia
What symptoms might indicate locally invasive prostate cancer?
haematuria
Haematospermia
Perineal or suprapubic pain
Impotence
Tenesmus-> due to prostate being pushed into rectum
Symptoms associated with obstructed ureters:
- loin pain
- anuria
- AKI/CKD
What symptoms might indicate metastatic prostate cancer?
Bone pain or sciatica
Paraplegia-> due to spinal cord compression
Lymph node enlargement
Loin pain or anuria
Lethargy-> anaemia and uraemia
Weight loss/cachexia
What are the 2 types of LUT symptoms and which type is seen in prostate cancer?
Voiding symptoms: -> see in prostate cancer due to it causing outflow obstruction
- straining
- hesitancy
- poor stream
- intermittency
- terminal dribble
- feeling of incomplete emptying
Storage:
- frequency
- urgency
- nocturia
- dysuria
What investigations are done if someone is suspected of having prostate cancer?
What would findings would be indicative of prostate cancer?
DRE -hard and irregular mass -multiple different nodules -assymetrical -lack of mobility due to tethering to surrounding tissue -palpable seminal vesicles -loss of central sulcus NOTE: any of these findings would trigger 2 week wait pathway
PSA
-raised
Urinalysis/U+E/RFT
-exclude renal or bladder pathology
Multiparametric MRI
- 1st line for suspected localised prostate cancer
- used to produce Likert score which expresses the likelihood of mass being prostate cancer
Prostate biopsy
-decision for biopsy dependent on MRI findings (>3 Likert score) + DRE/PSA results
Isotope bone scan
-looking for bone mets
What is PSA and why is it used to investigation prostate cancer?
Why is it not a reliable indicator of disease?
What is important to explain to patient who might need a PSA test?
Prostate specific antigen= glycoprotein produced by the epithelial cells of the prostate which help to thin semen into liquid consistency after ejaculation
Raised levels associated with prostate cancer
Not reliable due to high false positive rate due to PSA being raised for number of other reasons:
- BPH
- prostatitis
- UTI
- vigorous exercise esp cycling
- ejaculation or prostate stimulation
Need to counsell them on the implications of PSA test:
FP:
-might have invasive procedures such as biopsy (which carries out risks and complications) unnecessarily
-might lead to treatment of prostate cancer that might never have caused a problem
FN
-can lead to false reassurance and lead to patient not being as vigilant
What are the 2 options for prostate biopsy?
Waht are the main risks of prostate biopsy?
Why might you get a false negative result with biopsy and what is done to try and reduce the FN rate?
Transrectal ultrasound-guided biopsy (TRUS)
- probe inserted into rectum and provides good idea of size and shape of prostate
- biopsy taken through wall
Transperineal biopsy
-needle through the perineum under LA
Risks:
- pain-> lower abdo/rectal/perineal
- bleeding -> urine or faeces
- infection
- urinary retention due to inducing swelling of prostate
- erectile dysfunction
FN due to biopsy needle missing the cancerous area
To reduce FN, use multiple needles to take samples from multiple areas of prostate
How would you differentiate between BPH, prostatitis and prostate cancer on DRE?
BPH:
- smooth
- symmetrical
- soft
- maintain central sulcus between lobes
Prostatitis
- enlarged
- tender
- warm
Cancer
- firm + hard
- craggy or irregular i.e. feels nodular
- loss of central sulcus
What is the Gleason grading system?
How is the score generated?
What is it’s use in prostate cancer?
Grading of prostate cancer based on histological findings
-high gleason= poorly differentiated-> worse prognosis
Uses 2 numbers: 1st is the grade of most prevalent pattern and 2nd is grade of 2nd most prevalent pattern
Used to determine which treatment is most appropriate
6= low risk 7= intermediate risk 8+ = high risk
What is used to stage prostate cancer?
What are the parameteres for T?
TNM
Tx= unable to assess size 1- too small to be seen/felt 2-contained w/i prostate 3- extends out of prostate 4- spread to nearby organs
How is prostate cancer managed?
Watchful waiting
-when slow growing and not causing harm
Active surveillance
-regular follow ups
Radical prostatectomy
External beam radiation therapy
Brachytherapy (Interstitial radiation implants)
-implants deliver continuous targeted radiotherapy from the implanted seeds
Hormone therapy (Cryoablation androgen deprivation therapy) -tends to be used in combo with radio or alone if advanced disease
High intensity focused ultrasound (HIFU)
