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3rd Year Semester 1 > prostate cancer > Flashcards

prostate cancer Flashcards

1
Q

Zones of the Prostate

A

central zone :5%-10%
transitional :10-15
peripheral :80-85

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2
Q

Signs and Symptoms of localised prostate

A

generally asymtomatic
usually diagnosed thru PSA or DRE screening based on risk factors

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3
Q

Signs and Symptoms locally advanced tumours

A

urinary hesistancy
weakened stream
increased frequency, urgency nocturia
ED

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4
Q

Signs and Symptoms of. Late stage tumours

A

bone pain eg lower back , hip , upper thigh

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5
Q

TURP
what does it stand for

A

transuretheral resection of prostate

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6
Q

how does TURP work

A

needle is inserted into urethra via penis

prostate tissue trimmed away to relieve urinary symptoms associated with Benign prostatic hyperplasia (BPH)

Tissue taken away to pathology , RT delayed for 4-6 wks

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7
Q

DRE (digital rectal exam)

A

prostate tumours are firm but surrounded by compressible tissue

difficult to palpate SVs: superior firm indiciates SV involvement

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8
Q

PSA

A

protein produced by prostate and found in blood , not cancer specific only organ specific

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9
Q

Increased PSA indicates

A

Infection
prostatitis
BPH
cancer

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10
Q

what PSA is considered elevated

A

greater than 4ng/ml

PSA elevation does not correspond w tumour stage, but will influence risk group

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11
Q

raised age related PSA

A

under 50 ≥2µg/L
50-59 ≥3µg/L
60-69 ≥4µg/L
70+ ≥5µg/L

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12
Q

Diagnostic Workup – Physical Examination

A

after PSA or DRE

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13
Q

What does TRUS stand for

A

transrectal ultrasound scan

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14
Q

Diagnostic Workup - TRUS

A

only 60% tumours are visible on TRUS
not great for screening, diagnosis or staging

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15
Q

Limitations of TRUS

A

-calfications can result in poor image quality
-peripheral zone cane be difficult to see
-operator dependent (am. of pressure can decrease image quality)

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16
Q

Core Needle Biopsy

A

Systematic biopsy:
10-12 samples taken
base , mid and apex bilaterally
Guided by US

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17
Q

Gleason score
1
2

A

-small uniform cell w minimal nuclear changes

-still separated by stroma but more closely arranged

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18
Q

Gleason score
3
4

A

-varaition in glandular size and organisation w infiltration in stromal and neighbouring tissues

-atypical cells w extensive infiltration into surrounding tissues

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19
Q

Gleason score 5

A

sheets of undifferentiated cancer cells

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20
Q

ISUP Grade group:
grade 1
2
3
4
5

A

GS ≤ 6
GS 3+4=7
GS 4+3=7
GS 4+4=8; 3+5=8; 5+3=8
GS 9-10

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21
Q

Gleason Score
added up to be :
-2-6
-7
-8-10

A

-well differentiated , low grade
-moderately differentiated, intermediated. risk
-poorly differentiated , high grade

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22
Q

system for staging
system for grading

A

-TNM
-ISUP

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23
Q

Further Imaging: based on PSA,DRE and GS

A

abdomen/pelvis CT w contrast
MRI
PSMA PET

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24
Q

Abdo/Pelvic CT w/ contrast

A

-for lymphatic spread , which can also be determined thru dissection

-mpMRI is preferred over CT for abdominal/pelvic mets

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25
Q

MRI

A

better soft tissue delineation than pelvic CT
asses extra capsular extension and SV involvement
if biopsy comes back negative but still suspicion of cancer

26
Q

PSMA PET (or Isotropic Bone Scan)
reserved for patients with:

A

-high risk of skeletal mets
-T3a
-grade group 4or5
-PSA>20µg/L

27
Q

when is PSMA PET used

A

all patients w symptoms of bony mets
biochemical recurrence following prostatectomy
in assessment of ADT every 6 -12 months

28
Q

Most common sites of metastatic disease

A

bones
brain
lungs
liver
lymph nodes

29
Q

Watchful Waiting:
1.tx intent:
2.follow up:
3.assessment/markers used:
4.life expectancy
5.aim:
6.for:

A

-1.palliative
-2.patient specific
-3.not predefined
-4.less than 10 years
-5.minimize toxicity
-6.patients w all stages

30
Q

treatment options :watchful waiting

A

TURP for urinary support
hormone therapy

31
Q

Watchful Waiting:
what is it

A

-Deferred treatment until local or distant disease progression
-if progression=observation continues until symptoms
-prostate cancer slow growing tf safe option for those w/ limited life expectancy

32
Q

active surveillence:
1.tx intent:
2.follow up:
3.assessment/markers used:
4.life expectancy
5.aim:
6.for:

A

-1.curative
-2.predefined schedule
-3.DRE,PSA, mpMRI
-4.more than 10 yrs
-5.minimize toxicity w/o comprimising survival
-6.low-risk patients

33
Q

Active Surveillance
patient selection:

A

-life exp >10 years
-ISUP group 1
-T1-T2

34
Q

Treatment Options: Surgery

A

removal prostate , sv and surrounding tissue for clear margins

35
Q

pelvic lymph node dissection (PLND)

A

may not improve oncology outcomes but gives important staging info

36
Q

side effects of surgery

A

ED
Incontinence

37
Q

management of incontinence

A

-pelvic muscle re-education, bladder training
-anticholinergic medications
-artifical sphincter surgery

38
Q

Hormone Therapy

A

Androgens or male hormones stimulate prostate cancer cells to grow

Androgen deprivation therapy ADT supresses production of these hormones and shrink or slow the growth rate of prostate cancer

39
Q

risk and ADT

A

low risk= ADT not recommends

intermediate risk= consider 6 month of neo-adjuvant ADT
especially at risk for SV involvement

high risk=long term ADT : 3 years

40
Q

what is used to compliment ADT

A

EBRT

41
Q

How is Brachytherapy delivered?
LDR

A

-permanent radioactive seeds are deposited at pre-defined position and left there for 1-7 days.

42
Q

Brachytherapy: LDR
Treatment delivery/Seed placement

A

mick applicator: single seed placement
strand technique: preloaded needles and less chance of seed migration

43
Q

Brachytherapy: HDR
how does it work

A

temporary implant of catheters of IR-192 w different dwell times at each stopping point

44
Q

How is Brachytherapy delivered?
HDR

A

-sources are left to dwell in prostate
-positions and dwell times are pre defined
-just 10 to 20 minutes at a time

45
Q

Brachytherapy: HDR
benefits

A

improve target coverage
improved sparing of normal structures
improve potential to dose escalate sub volumes

46
Q

Brachytherapy: HDR
methods

A

single step procedure (ultrasound guided)
two step procedure (ultrasound for implantation and CT/MRI for planning)

47
Q

Brachytherapy: HDR
steps involved

A

1.placement of catheters
2.imaging with catheters in place
3.target volume defintion
4.dosimetry/planning (dwell time optimisation)
5.QA
6.Treatment delivery

48
Q

Brachytherapy: HDR
planning
verification

A

forward or inverse depending of software available
catheter tip verification is done pre irradiation

49
Q

Side Effects: Brachytherapy
what side effects
when they start
how long they last

A

Urinary side effects:
-frequency, urgency, pain and obstruction due to prostate swelling
-6-12 weeks following seed insertion
-2-12 months

50
Q

adjuvant radiation therapy

A

performed 4 months after surgery and triggered by tumour size or surgical margin …..60-64Gy

51
Q

salvage radiation therapy

A

perfomed when PSA levels increase during follow up

52
Q

Treatment decisions should take into account:

A

-TNM classification
-gleason score
-baseline PSA
-patient age , co-morbidity, life expectancy and QoL
-wishes and circumstance of patient

53
Q

RT: CT Simulation
what is needed
how is it achieved

A

empty rectum

diet
enema- microlax
endo-rectal balloon- filling the rectum for consistency

54
Q

RT: CT Simulation
-slice thickness

A

2.5-3mm

55
Q

RT: CT Simulation
scan length

A

SUPERIOR: sacroiliac joint for prostate +/-SVs OR
post prostatectomy
L4/L5 for distal common iliac or proximal pre-sacral lymph nodes for high risk patients

INFERIOR:fixed border taken from ischial tuberiosties eg 5cm inf

56
Q

Advantages of MRI at Pre Treatment

A
  • decreases of CTV which leads to:
57
Q

Prostate CTV

A

entire prostate gland as defined on planning CT with aid of MRI

58
Q

strengths of HDR

A

-implant large glands
-implant extra capsular extension/SV
-Accurate dose delivery
-Focal subvolume boosts

59
Q

limitations of HDR

A

-Fractionation
-Requires HDR facility

60
Q

strengths of LDR

A

-single step procedure
-convenient
-Well established technique with large amounts
of historical data

61
Q

limitations of LDR

A

-Volume limited
-Limited cover of extra capsular extension/SV
-Possible seed migration
-Less flexible for boosts
-Low radioprotection

3rd Year Semester 1 (55 decks)

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