Prostate Cancer Flashcards
Red flags and referrals for prostate cancer
NICE guidelines say that PSA (more on this shortly!) and DRE should be considered in any male with:
Visible haematuria
Erectile dysfunction
Any lower urinary tract symptoms
2WW should also be done if prostate feels malignant (asymmetrical,
enlarged, nodular)
A 2WW should be done for any male whose PSA is above normal limits
Investigations for suspected prostate cancer in a primary setting
Primary care:
⚫ Urinalysis (r/o UTI)
⚫ Bloods including PSA, FBC, U&E, LFT
⚫ DRE (hard, sometimes nodular)
⚫ Referral
Urology referral:
Transrectal Ultrasound
Biopsy (TRUS needle guided)
Staging investigations
Prostate biopsy and procedure risks
Quite a high risk procedure
Only carry out if definite that PSA is rising with likelihood due to prostate cancer
Local anaesthetic in rectum
Ultrasound probe inserted into rectum with fine needle attached
Images can be used to guide samples – approx 12 are taken to ensure good representation
Risks:
Blood in semen, urine and back passage is present in nearly all cases for 2 weeks – 2 months. Risk – can become uncontrolled
Can cause pain and discomfort during and after
Infection is a risk – 3% chance of sepsis
1 in 50 develop urinary retention
Erectile dysfunction (usually resolves after 2 months)
Where could prostate cancer likely metastasise to?
Most common site of metastasis is the bones (80% of advanced prostate cancers) - common symptom of this is loin/ back pain
Also very common is the lymph nodes, especially in the pelvic area
Liver, bladder, spleen, brain, lung have also been reported
What type of cancer is most prostate cancer?
Adenocarcinoma
What treatment is available for prostate cancer?
Treatment depends on: location of cancer, staging, type, grading, and general health and fitness of patient
One option is not to do anything straight away and monitor closely. These are known as watchful waiting and active surveillance.
Other options include: surgery (radical prostatectomy), external radiotherapy, internal radiotherapy aka brachytherapy, hormone therapy, or palliative care.
Surgery or radiotherapy work equally well at curing early prostate cancer
What is active surveillance in terms of cancer treatment?
Used for low risk, localised cancers that could be cured by future treatment, AND intermediate risk localised cancers when the patient does not wish to persue treatment immediately
What is watchful waiting in terms of prostate cancer treatment?
Watchful Waiting
Less intense than active surveillance
Used for patients who have
1. no symptoms from localised Ca and health problems that prevent radical curative measures
2. no symptoms from advanced Ca
3. localised Ca and do not wish to undergo AS
What is a radial prostatectomy?
Involves removal of the entire prostate gland between the urethra and bladder, and resection of both seminal vesicles, along with sufficient surrounding tissue to obtain a negative margin. Often accompanied by bilateral pelvic LN dissection.
Risks and side effects of a radial prostatectomy?
Risks include infection, bleeding, problems caused by anaesthetic, damage to local structures, and blood clots.
Side effects are commonly urinary incontinence after removal of catheter (lasts 1-6m usually but sometimes forever) and urinary retention. Most men suffer erectile problems for several years after the operation, along with penis shortening, “dry orgasms” and infertility (plus loss of sensation/pleasure for those that enjoy stimulation of prostate)
What is external beam radiotherapy?
And it’s side effects?
(Prostate cancer treatment)
⚫ Involves daily visits to the hospital for 7-8 weeks and highly-focused x-ray beam used to destroy cancer cells in prostate and any local invasion
⚫ Side effects include: urinary problems, bowel issues, fatigue, dry orgasm and infertility, skin irritation and hair loss, erection problems, lymphodema, bone pain, increasd risk of bladder/bowel Ca.
What is seed brachytherapy?
And what are the side effects?
(Prostate Ca treatment)
⚫ Tiny, radioactive, rice-grain sized gold seeds are implanted into the prostate to deliver targeted radiation
⚫ Implanted under general anaesthetic or with an epidural – usually as an inpatient for 1-2 days
⚫ Side effects include: haematuria or haemospermia, pain and bruising, urinary problems, erection problems, fatigue, infertility.
⚫ Need to avoid being within 0.5m of pregnant women or children for 3m after starting treatment
⚫ Can be used in conjunction with external beam therapy
Describe hormone therapy and it’s side effects in use of prostate cancer treatment
⚫ Not curative on it’s own. Works by blocking body from producting testosterone, or preventing it reaching Ca cells. Often used as an adjuvant to radiotherapy, but not to those having surgery.
⚫ Shrinks the cancer and slows growth
⚫ Injections to prevent testicles creating testosterone; tablets to block the effects, or surgery to remove testicles
⚫ Side effects are those of low test: hot flushes, loss of lbiido/erections, breast swelling, weight gain, muscle loss, mood issues, loss of body hair - feminisation
What is PSA?
Prostate-specific antigen, a glycoprotein produced exclusively by the prostate.
It’s “job” is to liquefy semen and protect sperm, as well as dissolving cervical mucus.
PSA normal ranges
⚫ Normal range is from 0-4 nanograms/mL
⚫ NICE suggests referring anyone of any race or
age who have a PSA >3ng/mL
⚫ Some studies promote an age/race model ie increase age, increase PSA norm range
