Prostate cancer Flashcards
What is the most common type of prostate cancer
adenocarcinoma -95% of them
How is prostate cancer graded
Gleason system
2 grades
1 grade is assigned to most dominant pattern and then 2nd grade to second most predominant pattern
range from 2-10 , 2 being lowest and 10 being the highest
Where does lymphatic spread occur first
obturator nodes
What spread is usually associated with distant disease
local extraprostatic spread to seminal vesicles
What may someone with prostate cancer present with
LUTS - storage and voiding symptoms
- frequency
-urgency
-nocturia
-dysuria
-hesitancy
-incomplete voiding
-poor stream
haematuria
bone pain
FLAWS
What investigations are required for prostate cancer
urinalysis
DRE
- asymmetrical hard nodular prostate
-loss of midline sulcus
PSA- non specific
Transrectal ultrasound guided needle biopsy
Isotope bone scan for staging
How do you manage localised prostate cancer
T1/T2
active monitoring and watchful waiting if significant comorbidities
Radical prostatectomy - can cause ED
Radiotherapy - increases risk of bladder, colon and rectal cancer
How do you manage locally advanced prostate cancer
T3/T4
hormonal therapy
radical prostatectomy
radiotherapy
How do you manage metastatic prostate cancer
hormonal/anti-androgen therapy
- synthetic GnRH agonists/antagonists
GnRH agonist -GOSERELIN
How does goserelin work
paradoxically results in lower LH levels longer term by causing overstimulation - disrupts endogenous hormonal feedback symptoms
Hence testosterone level will rise before it falls
What is bicalutamide
non-steroidal anti androgen
blocks androgen receptor
What is a steroidal anti-androgen that is given in patients with metastatic disease
cyproterone acetate
prevents DHT binding from intracytoplasmic protein complexes
used less commonly now
What androgen synthesis inhibitor is used for metastatic disease
abiraterone
What surgical option can be given to patients with prostate cancer
bilateral orchidectomy
used to rapidly reduce testosterone levels
What can be a complication of radiotherapy
proctitis- inflammation of lining of rectum
