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prostate cancer Flashcards

1
Q

what is the most common malignancy in men?

A

prostate cancer

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2
Q

what are the 4 zones of the prostate?

A
  • 4 main zones: peripheral (posterior), fibromuscular (anterior), central (central) and transitional zone (surrounding urethra)
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3
Q

what are the RF for prostate cancer?

A
  • Age >50
  • Black
  • Family history of prostate cancer
  • Family history of heritable cancers eg breast or colorectal
  • High levels of dietary fat
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4
Q

what symptoms can be seen with prostate cancer?

A

asymptomatic - incidentally picked up
lower urinary tract symptoms
: haematuria, haematospermia, weight loss, weakness, fatigue, bone pain

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5
Q

why might bone pain occur with prostate cancer?

A

likely to met in bones especially hip/ pelvis

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6
Q

what are lower urinary tract symptoms?

A

frequency, uregency, nocturia and hesitancy, dysuria and post void dribbling are most common

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7
Q

what are important aspects of history to ask about?

A
  • Past medical history including hospitalisation, surgical procedures and history of pelvic radiation
  • Medications
  • Family history: prostate cancer in a first degree relative under 65 and breast cancer  BRCA2 gene
  • Social: alcohol intake, smoking (affects prognosis) and recreational drug use
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8
Q

what would a DRE examination reveal to indicate PC?

A

asymmetrical prostate, nodular and indurated

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9
Q

what regions of the prostate can a DRE palpate?

A

may only detect in posterior and lateral aspects due to be only palpable regions.

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10
Q

what are differentials of PC?

A

BPH
chronic prostatitis
urethral instrumentation
UTI

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11
Q

how would you differentiate between BPH and PC?

A

Benign prostatic hyperplasia: DRE  enlarged but symmetrical
- Biopsy would differentiate between

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12
Q

how would you differentiate chronic prostatitis and PC?

A

Chronic prostatitis: symptoms develop over 3mths to a 1yr
- Microscopy of prostate secretions reveal leukocytes and inflammation
- PSA mildly elevated
- Will resolve with antibiotics

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13
Q

what would point more towards urethral instrumentation?

A

history of recent intervention will temporary elevate PSA

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14
Q

what can elevate PSA?

A

cancer, BPH, prostatitis, UTI (avoid testing for 6weeks after0, VIGROUS EXERCISE, sexual activity (avoid ejaculation for 48hrs before test), DRE- avoid for 7days prior to test, catheter – avoid 6weeks before test, biopsy – avoid for 6weeks prior to test

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15
Q

what can U&Es show while investigating PC?

A

cancer may obstruct ureters leading to hydronephrosis and kidney dysfunction

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16
Q

what scale is used for a multiparametric MRI?

A
  • Multiparametric MRI: if PSA indicates, gives a 5point likert scale  biopsy required in those with 3+
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17
Q

why would you do a DEZA scan?

A

boney mets

18
Q

why would you do a CT abdo, pelvis?

A

for mets

19
Q

what is a PSMA PET used for?

A
  • PSMA PET for detecting mets in those with low PSA
20
Q

what methods can be used for a prostate biopsy?

A
  • Template transperineally biopsy under GA
  • Transperineal biopsy under LA
  • Transrectal ultrasound (TRUS) guided needle biopsy
  • MRI- TRUS fusion guided needle biopsy
  • PSA -membrane PET scan is most sensitive for detecting recurrent disease
21
Q

how is PC graded?

A

gleason grading

22
Q

can biopsy miss diagnosis of PC?

A

up to 20%

23
Q

what are the advantages of PSA screening?

A
  • Improved prognosis by early detection
  • Less radical treatment due to early curing
  • Reassurance to those with negative results
24
Q

what are the disadvantages of screening?

A
  • Anxiety and morbidity with false positives
  • Unnecessary intervention with false positives
  • ## Hazards of screening eg radiation
25
Q

what is normal PSA levels?

A

0-4ng/ml

26
Q

how would you manage low risk PC?

A

watchful waiting
active surveillance

27
Q

what is watchful waiting?

A

no treatment but regular DRE and PSA tests  any significant changes, palliative care may be initiated

28
Q

what is active surveillance?

A

surveillance (intent for curative treatment but delayed): regular DRE, PSA tests and often prostate biopsies  any change hormonal, radiotherapy, surgery may be initiated

29
Q

what management options are available for intermediate risk of PC?

A

active surveillance
surgery

30
Q

what are the surgical options of PC?

A

radical prostateectomy
external beam radiotherapy
brachytherapy

31
Q

what occurs during a radical prostatectomy?

A

removal of prostate through open, laproscopic or robot assisted approaches

32
Q

what is external beam radiotherapy?

A

beams of radiation are targeted to cancer cell sin prostate and therapy is given for 7-8weeks

33
Q

what is brachytherapy?

A

permanent implantation of small beads of radiation into prostate gland  shrinks tumours

34
Q

what management options are available for high risk PC?

A
  • Active surveillance
  • Radical prostatectomy
  • External beam radiation + hormone therapy
35
Q

what options can be used in hormone therapy?

A
  • Gonadotrophin releasing hormone: GnRH antagonist  less testosterone (shrink gland and associated malignancy)
  • Androgen receptor antagonists: bicalutamide and flutamide  less androgen driven malignancy growth
36
Q

what side effects can occur with hormone therapy?

A

hot flushes, decreased bone density, fractures, low libido, erectile dsyfucntion, altered lipids and more

37
Q

how can a bilateral orchiectomy be used to manage PC?

A

removal of testicles which starves prostate of testosterone

38
Q

why is oestrogen therapy not used in practice alot?

A

not used as frequently  decreases testosterone ( side effects: breast enlargement and venous thromboembolism)

39
Q

what are the side effects of radical therapy?

A
  • Dysuria
  • Urinary frequency
  • Urinary incontinence
  • Rectal bleeding/ proctitis (mainly with radiotherapy)
  • Erectile dysfunction  may be caused surgery or androgen deprivation therapy
40
Q
A

GU (4 decks)

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