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4th Year Unseen Exam > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

Discuss the anatomy of the prostate gland

A

It is at the base of the bladder, at the beginning of the urethra. Any growth will prevent urinary flow

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2
Q

What are the risk factors for prostate cancer?

A
  • exogenous testosterone
  • age
  • family history
  • afro-caribbean origin
  • smokers
  • androgen levels
  • dietary influences
  • weight
  • infections with STDs, multiple partners
  • increased frequency of ejaculation
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3
Q

How is prostate cancer screened for?

A

Prostate specific antigen testing or digital rectal examination

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4
Q

What are common presentations of prostate cancer?

A
  • benign prostate hyperplasia mimics prostate cancer

URINARY SYMPTOMS: increased frequency of urination, nocturia, urgency, hesitancy, reduced urinary flow, incomplete bladder emptying, infection

  • elevated PSA
  • blood in ejaculate
  • many men are asymptomatic
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5
Q

What are symptoms of advanced disease associated with prostate cancer?

A

bone pain, anaemia, other symptoms of metastatic spread

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6
Q

Which investigations are carried out for prostate cancer?

A

TRUS - takes tissue from the prostate gland, can sometimes miss the cancer so multiple biopsies are taken

  • CT scan, bone scan, MRI scan
  • digital rectal exam
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7
Q

How is prostate cancer staged?

A

Using the gleason scale, first number is the most predominant cell type and second is the second most predominant cell type

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8
Q

What are the T stages for prostate cancer?

A

T1 - small tumour within the prostate gland, too small to be detected and generally causes no symptoms
T2 - tumour is still within the prostate, but is large enough to be detected
T3 AND 4 - tumour has spread to surrounding tissue

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9
Q

Which T stages related to localised prostate cancer?

A

T1 and 2

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10
Q

Which T stages relate to locally advanced prostate cancer?

A

T3 and 4

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11
Q

What are the N stages for prostate cancer?

A

N1 - cancer in nearby lymph nodes

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12
Q

What are the M stages for prostate cancer?

A

M1a - cancer has spread to other lymph nodes

M1b - cancer in the bones

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13
Q

Which stages relate to metastatic prostate cancer?

A

N1, any M

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14
Q

Which stages of prostate cancer are classed as low risk?

A

T1-T2a, gleason less than 6

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15
Q

Which stages of prostate cancer are classed as intermediate risk?

A

T2b, gleason 7

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16
Q

Which stages of prostate cancer are classed as high risk?

A

T2c and 8-10 gleason

17
Q

How are low risk prostate cancers treated?

A

Active surveillance, watchful waiting, radical prostactomy or radiotherapy

18
Q

How is intermediate risk prostate cancer treated?

A

Patients offered radical treatment.
If gleason score is more than 8 then adjuvant hormonal therapy recommended for 2 years post RT.
Check prostate stimulating hormone levels

19
Q

How is high risk prostate cancer treated?

A

Radical prostectamy/radiotherapy
6 months of androgen deprivation therapy
radiotherapy
high dose brachytherapy

20
Q

What are the options for radical radiotherapy?

A

Radiotherapy focused on the prostate, radioactive seeds to prostate, cryotherapy

21
Q

What are the adverse effects of radical radiotherapy?

A
  • problematic as the urethra runs through the prostate
  • incontinence
  • loss of sexual function
  • impotence
  • bowel problems
22
Q

How is locally advanced prostate cancer treated?

A

Leutenising hormone releasing hormone antagonists

23
Q

Give some examples of LHRHA

A

buserelin, goserelin, triptorelin, leuprorelin

24
Q

How is goserelin administerd?

A

Zoladex is administered as a prefilled syringe, available as 4/12 weekly implants or nasal sprays

25
Q

How do 4/12 weekly implants of zoladex work?

A

Pellet is implanted into the empidermis and leeches out the drug

26
Q

What is the normal process of the prostate cell cycle?

A

hypothalamus reduces LHRH to pituitary gland, which releases LH to the testes, which releases testosterone and signals to to prostate to regulate cell cycle, cells die and grow normally, but in prostate cancer prostate cells proliferate uncontrollably. There is also a release of adrenal corticotrophic hormone from pituitary gland which stimulates the adrenal gland, producing adrenal androgens, that stimulate the prostate.

27
Q

What can LHRAa cause initially?

A

Initial surge in testosterone, causing a tumour flare. Anti androgens can be given 3 days prior to giving LHRHa and continued for up to 3 weeks after. Degarelix does not cause this as it is a LHRH antagonist

28
Q

What are the adverse effects of LHRAa?

A

Hot flushes, inplantation site reactions, loss of libido

29
Q

When are anti-androgens added in to treatment?

A

When men are not responding well enough to LHRAa/to prevent tumour flare

30
Q

Give some examples of anti-androgens

A

Flutamide, bicalutamide, cyproterone

31
Q

How do anti-androgens work?

A

Competitiively inhibit the androgen receptors, which inhibits testosterone release. Has similar adverse effects to LHRHa

32
Q

How does hormone resistant disease occur?

A

There is not just one way to produce testosterone. Cell signalling systems change and this leads to an up regulation of the androgen receptor in cells, anti androgens can even become agonists

33
Q

How is advanced prostate cancer treated?

A
  • Dexamethasone
  • radiotherapy
  • bisphosphonates or strontium for bone pain
  • chemotherapy
34
Q

Which further treatments can be given to patients that stop responding to hormonal therapies but have not had chemotherapy?

A
  • enzalutamide and arbiratone
35
Q

Which chemotherapy drugs are given for prostate cancer and when are they indicated?

A

Docetaxel, mitoxantrone, estramustine. Given in advanced hormone refractory disease

36
Q

How do LHRHa agonists work?

A

LHRHa agonists stimulate the pituatry to produce LH which results in increased testosterone which leads to a negative feedback loop, as the hypothalamus decreases the release of LHRH, and this leads to a fall in testosterone and the tumour shrinks

4th Year Unseen Exam (17 decks)

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