Prostate cancer Flashcards
What are the risk factors for prostate cancer
Increasing age
Family history
Black African or Caribbean origin
Tall stature
Anabolic steroids
How can it present?
Asymptomatic
LUTS
Haematuria
Erectile dysfunction
Symptoms of advanced disease or metastasis - weight loss, bone pain, CES
How does a cancerous prostate feel on dRE?
Firm, hard
Asymmetrical
Craggy or irregular
Loss of central sulcus
What is first line investigation
Multiparametric MRI
When should a prostate biopsy be done?
MRI findings showing Likert 3 or above and clinical suspicionWa
What are options for prostate biopsy
Transrectal US guided biopsy TRUS
Transperineal biopsy
What are risks of prostate biopsy?
Pain
bleeding
infection
urinary retention
erectile dysfunction
How are metastasis investigated for
Isotope bone scan
How is prostate cancer graded? Based on what ? What indicates a high risk score
Gleason grading system
Histology
Higher score
Also TNM staging
Explain TNM staging for prostate cancer
T - tumour
Tx - unable to assess size
T1 - too small to be felt on examination or seen on scans
T2 – contained within the prostate
T3 – extends out of the prostate
T4 – spread to nearby organs
N - nodes
NX - unable to assess
N0 - no nodal spread
N1 - spread to lymph nodes
M0 - no metastasis
M1 - mets
What are treatment options
- surveillance or watchful waiting
- External beam radiotherapy
- Brachytherapy
- Hormone therapy
- Surgery
What is a complication of external beam radiotherapy ?How is it managed?
Proctitis
Prednisolone suppositories
What is brachytherapy
Implanting radioactive metal seeds into the prostate delivering continuous radiotherapy to the prostate
What are complications of brachytherapy
Cystitis, proctitis
Erectile dysfunction
Incontinence
Increased risk of bladder or rectal cancer
What are side effects of hormone therapy
Hot flushes
Sexual dysfunction
gynaecomastia
Fatigue
Osteoporosis
