Prostate cancer

Question 1

OVERVIEW
i) which two areas do aggresive PC usually spread to?
ii) what do they rely on to grow?
iii) which histol subtype are most? which area of the prostate do they grow?
iv) name four risk factors

Answer 1

i) lymph nodes and bone
ii) rely on androgen hormones eg testosterone
iii) most are adenocarcinomas and grow in the peripheral zone of the prostate
iv) RFs inc age, FH, black, tall, anabolic steroid use

Question 2

PRESENTATION
i) what type of symptoms may they px with? what condition is this simular to?
ii) name four common symptoms
iii) name three symptoms of advanced disease

Answer 2

i) lower UT symptoms - similar to BPH
ii) hesitancy, frequency, weak flow, terminal dribbling, nocturia, haematuria, erectile dysfunc
iii) met - weight loss, bone pain, cauda equina syndrome

Question 3

PSA
i) which cells in the protein produce PSA? what type of protein is it? how is it secreted?
ii) what role does it play? is it produced anywhere apart from the prostate?
iii) name four other common causes of raised PSA
iv) what are the two main problems when using pSA to investigate for prostate cancer?

Answer 3

i) epithelial cells in the prostate produce it, glycoprotein, secreted in the semen and a small amount enters the blood
ii) thins the thick semenn to a liquid consistency for ejaculation
only produced in the prostate
iii) prostate cancer, BPH, prostatitis, UTIs, vigorous exercise (cycling), recent ejac or prostate stimulation
iv) false positives (75%) and false negatives (15%)

Question 4

PC INVESTIGATIONS
i) what type of scan is first line investigation? how are results reported?
ii) what imaging result warrants a prostate biopsy? which two techniques can be used to biopsy?
iii) name three risks of prostate biopsy
iv) which scan can be used to look for bony metastasis? how does it work?

Answer 4

i) multiparametric MRI
results reported on a likert scale (1-5) 1 = low suspicion, 5 = definite cancer
ii) biopsy if MRI score 3+
do transrectal US guided biopsy or transperineal biopsy
iii) risks - pain, bleeding, infection, urinary retention, erectile dysfunc
iv) isotope bone scan > give RA isotope by IV infection and wait 2-3 hours > gamma camera to look at skeleton (met bone lesions take up the isotope)

Question 5

STAGING
i) which grading system is used and is based on histology? how does the score change in relation to how differentiated the tumour is
ii) what is the score made up of? which score is deemed high risk?
iii) what staging system is used?

Answer 5

i) gleason grading system based on histology from prostate biopsies
higher score with a more poorly differentiated tumour
ii) two numbers - first number is most prevalent pattern in the biopsy and second number is the second most prev pattern in the biopsy
8+ is high risk
iii) TNM staging

Question 6

MANAGEMENT
i) what may be done in early PC? name three types of therapy that may be given
ii) what is a key complication of external beam RT? name three symptoms? what can be given to treat?
iii) which treatment involves implanting RA seeds into the prostate which deliver continuous targeted RT? name two SEs
iv) how does hormone therapy work? name two types? name three side effects
v) what surgical prcedure may be done? name two side effects

Answer 6

i) watch and wait
can give external bean RT to prostate, brachytherapy, hormone therapy, surgery
ii) ext beam RT > proctitis (rectal inflam( > pain, altered bowel habit, rectal bleeding, discharge
prednisolone suppositories can help
iii) brachytherapy
radiation can cause inflam in nearby organs eg bladder, rectum, erectile dysfunc, incontinence, risk of bladder/rectal cancer
iv) hormone therapy reduces level of androgens eg testos to stop cancer growing (can be used with RT)
androgen receptor blockers eg bicalutamide, GnRH agonists eg goserelin
SE are hot flushes, sexual dysfunc, gynaecomastia, fatigue, osteoporosis
v) radical prostatectomy > SE are erectile dysfunction and urinary incontinence