Prostate cancer Flashcards
Where is the prostate gland located
- at the base of the bladder and beginning of the urethra, that’s why its so hard to locate it
- it secretes the milky fluid which a component of semen
What are the risk factors for prostate cancer
- male sex
- age >50yrs
- family history
- african-american race
- smoking
- overweight
- dietary influences
- alcohol
- androgen levels - use of exogenous testosterone
- infections with STD/multiple sexual partners
- increased frequency of ejaculation
How is prostate cancer screened
- prostate specific antigen (PSA) - high levels indicative of cancer however a patient could have low levels and still have cancer so it is not a great tool
- digital rectal examinations
What are the signs and symptoms of prostate cancer
-can present quite late
- increase urination frequency
- nocturia
- urgency, hesitancy, and reduced flow
- incomplete bladder emptying
- infection
- elevated PSA or positive DRE
- blood in ejaculate
other symptoms could suggest more advanced disease
- bone pain
- anaemia
- DIC
How is prostate cancer investigated
-Transrectal ultrasound (TRUS)
- CT scanning
- MRI scanning
- radionuclide bone scan
What is a side-effect of Transrectal ultrasound (TRUS)
- can cause damage such as faecal and urinary incontinence, infection and erectile dysfunction
- it is also not very accurate
what is the Gleason scale staging of prostate cancer
it is the score of 2 most common miscroscopic cellular differentiation pattern of the prostate.
- the higher the first score then the more aggressive the cancer
- has a max score of 10
- a score of 6 could be 3+3 or 4+3
What is the TNM staging for prostate cancer
T1- small tumour within prostate gland - generally with no symptoms
T2 - tumour within prostate but large enough to be detec with rectal exam or ultrasound
T3 & 4- cancer spread to surrounding tissues
N1 - cancer spread to nearby lymph nodes
M1a - cancer spread to other lymph nodes not near the gland
M1b - cancer spread to the bones
What is localised prostate cancer, locally-advanced prostate cancer and metastatic prostate cancer
-localised prostate cancer - T1 and T2
-locally-advanced prostate cancer - T3 and &
T4
-metastatic prostate cancer - at N stage
what is the risk stratification for prostate cancer
Low risk - Gleason score ≤6 and T1-T2a
Intermediate risk - Gleason score 7 and T2b
High risk - Gleason score 8-10 and ≥T2c
What is the treatment plan for a low risk prostate cancer patient
- active surveillance
- radical prostatectomy & radiotherapy
What is the treatment plan for an intermediate risk prostate cancer patient
- radical prostatectomy & radiotherapy
- if Gleason score is ≥8.0 - then may require adjuvant hormonal therapy for 2 years.
What is the treatment plan for a high risk prostate cancer patient
- radical prostatectomy & radiotherapy
- 6 months - 3 years of androgen deprivation therapy
- external beam radiotherapy
- high dose rate brachytherapy
What adverse effects are seen with radical therapy
- incontinence
- loss of sexual function - could use sildenafil
- impotence
What treatment is used for locally advanced disease of prostate cancer and examples
- lutenising hormone-releasing hormone agonist (LHRHa)
e. g goserelin, leuprorelin
What is the MOA of lutenising hormone-releasing hormone agonist (LHRHa)
- a negative feedback loop occurs which leads to a reduction of testosterone so a decrease in tumour occurs
- the Hypothalamus releases LHRH to the pituitary gland
- the pituitary gland releases LH to the testis
- the testsis releases testosterone to the prostate
LHRHa works on the pituitary gland and causes a surge in the testosterone level so the hypothalamus stops releasing LHRH
How is lutenising hormone-releasing hormone agonist (LHRHa) treatment initiated
- 3 days of anti-androgen e.g cyproteron BEFORE administering LHRHa.
- it is then continued for 3 week alongside LHRHa
What is tumour flare and what can it cause
- it is caused by a surge in testosterone level due to LHRHa which can be elevated for 1-2 weeks.
- it can cause urinary obstruction, bone pain and nerve compression
What are the adverse effects of lutenising hormone-releasing hormone agonist (LHRHa)
- loss of libido
- hair loss
- impotence
- weight gain
- muscle loss
- enlargement of man breast
- hot flushes
- mood changes
- implantation site reaction
What is an example LHRH antagonist
- degarelix
- does not cause tumour flare
What is an example of anti-androgen and how does it work
e.g cyproterone, flutamide
MOA:
- competitively inhibits androgen receptor on prostate gland
- can be used alone or in combo w/ other therapies
- adverse effects similar to LHRHa
What is hormone resistant disease
-men will eventually become resistant to treatment at some stage and it leads to advanced disease
What is used in for refractory prostate cancer
Abirateron, enzalutamide
What is the MOA of anti-androgens
They block androgen receptor and prevents androgens from binding
