Prostate Cancer Flashcards
What are the risk factors for prostate cancer? (5 things)
- Age
- FHx
- High testosterone
- Black
- Obesity
What is the cause of growth in prostate cancer?
High androgens (testosterone / dihydrotestosterone)
What is the most common type of prostate cancer?
Adenocarcinoma (95%)
Where do prostate adenocarcinomas arise from? (3 things)
- Peripheral zone (75%)
- Transitional zone (20%)
- Central zone (5%)
What are the types of prostate adenocarcinoma? (2 things)
- Acinar adenocarcinoma (most common prostate cancer)
- Ductal adenocarcinoma
Where does Acinar adenocarcinoma arise from?
Glandular cells lining prostate
Where does Ductal adenocarcinoma arise from?
Cells lining duct of prostate gland
Which prostate adenocarcinoma grows + metastasises fastest?
Ductal adenocarcinoma
What are the clinical features of prostate cancer? (9 things)
- LUTS (freq, urgency, weak stream)
- Nocturia
- Haematuria (adv)
- Dysuria (adv)
- Incontinence (adv)
- Suprapubic pain (adv)
- Weight loss (metastasis)
- Bone pain (metastasis)
@ DRE (digital rectal examination)
9. Hard + irreg prostate
What are the some differentials that present similarly to prostate cancer? (6 things)
- BPH (also causes LUTS)
- Prostatitis
(also present with haematuria)
- Bladder cancer
- Urinary stones
- UTI
- Pyelonephritis
How do you differentiate between Prostatitis and Prostate cancer? (2 things)
- Prostatitis = perineal pain
- Prostatitis = neuts @ urinalysis
What lab test should be done for PSA?
PSA (prostate specific antigen test)
What is PSA?
Serum antigen produced by malignant AND healthy cells in prostate
RAISED in prostate cancer
How can PSA be raised artificially? (5 things)
- BPH
- Prostatitis
- Vigorous exercise (biking)
- Ejaculation
- Recent DRE
What other tests can you do to increase the accuracy of a PSA test? (2 things)
- Free:total PSA ratio (low = more likely cancer)
- PSA density (high = more likely cancer)
What are other investigations that can be done for prostate cancer? (2 things)
- MRI (done 1st, booked automatically on GP referral)
- Transrectal US
- Biopsy
How is staging done for in prostate cancer?
Intermediate - High risk disease
What investigations should you do for Staging the prostate cancer? (2 things)
- Abdo-pelvic CT
- Bone scan
What score is used for Grading prostate cancer?
Gleason score
How does prostate cancer spread? (3 things)
- Locally –> seminal vesicles, bladder, rectum
- Lymph
- Haematogenously –> sclerotic bony lesions
What does the management of prostate cancer depend on?
Progression of disease
What are the different management schemes for the different levels of prostate cancer?
- Low risk = active surveillance
- Intermediate risk = active surveillance / radical treatment
- High risk = radical treatment
- Metastatic = chemo + anti-hormonal agents
What is done in active surveillance of prostate cancer? (3 things)
- 3 monthly PSA
- 6 monthly DRE
- 1-3 yearly re-biopsy
What are the Radical treatment options for prostate cancer?
- Surgery
- Radiotherapy
- Chemo
What is the Radical surgical management of prostate cancer?
Radical prostatectomy (open / laparoscopic / robot)
What are the side fx of Radical prostatectomy? (3 things)
- Erectile dysf (60-90%)
- Stress incontinence
- Bladder neck stenosis
What are the types of Radical radiotherapy for prostate cancer? (2 things)
- External beam radiotherapy
- Brachytherapy
What are the indications of chemo in prostate cancer?
Only for metastasis
What are the types of chemo for prostate cancer?
- Docetaxel (for testosterone resistant cancer)
- Cabitaxel (w prednisolone) (for treating relapse after docetaxel not work)
