Prostate Cancer Flashcards
Risk factors of prostate cancer
Increasing age
Family history
BRCA2 gene mutation
Ethnicity - black people + Asians
anabolic steroids
What type of cancer is prostate cancer mostly?
adenocarinomas
What zone of the prostate are prostate cancers most commonly found?
peripheral zone
Presentation of prostate cancer
- can be asymptomatic
- symptoms of UTI
- bone pain - due to prostatism or metastatic disease in bone (often spine)
- ED
- haematuria
Prostate cancer in digital rectal exam
Hard
Irregular
Causes of raised prostate specific antigen
- Prostate cancer
- BPH
- UTI
- prostatitis
- urinary retention
- recent ejaculation or prostate stimulation e.g. post DRE
- vigorous exercise - cycling
Should a prostate specific antigen test be done before or after a digital rectal exam?
PSA before DRE
DRE can cause elevated PSA
Impact of false positive PSA test
- further unnecessary investigations e.g. invasive prostate biopsy
- extra stress
Impact of false negative PSA test
false reassurance
Histological grading of prostate cancer
Gleason classification
First line invesitgation of suspcted localised prostate cancer
multi parametric MRI
Diagnosis of prostate cancer
- hard + irregular prostate on DRE
- transrectal USS +/-biopsy
- increased PSA
- multiparametric MRI
- radiographs + bone scans to stage + identify metastatic spread
Two options for prostate biopsy
- transrectal USS guided biopsy
- transperineal biospy
Outline transrectal US guided biopsy of prostate
- USS probe inserted into rectum
- biopsy taken through wall of rectum into prostate
Outline tranperineal biopsy of prostate
needle inserted into perineum
under LA
Risks of prostate biopsy
- pain
- bleeding - stools, haematuria, haematospermia
- infection
- urinary retention
- ED
- false negative
What can patients with advanced prostate cancer develop?
Sclerotic bone legions
What is used to look for bony metastasis
isotope bone scan
(bone scintigraphy)
.
isotope given IV
Treatment of localised prostate cancer
Depends on stage on tumour
- watchful waiting
- surgery - prostatectomy
- hormone therapy
- brachytherapy
- external beam radiotherapy if unfit for surgery
Side effects of radiotherapy in prostate cancer
- discomfort around radiotherapy site
- diarrhoea
- loss of pubic hair
- tiredness
- inflammation of bladder lining
- erectile dysfunction
- proctitis - inflammation in rectum
Outline proctitis as a side effect of external beam radiotherapy
- inflammation in rectum
- causes pain, altered bowel habit, rectal bleeding + discharge
- prednisolone suppositories used to help inflammation
Side effects of prostatectomy
Urinary Incontience
Erectile dysfunction
Infertility
What are the emerging treatments of prostate cancer?
- Brachytherapy: radiation dose delivered inside prostate gland
- High intensity focused ultrasound: uses US waves to destroy cancerous prostate tissue
- Cryotherapy: cryoneedles inserted into prostate gland through rectum > freeze prostate gland
Treatment of advanced prostate cancer
- hormone manipulation: testosterone promotes tumour growth
- surgical castration
- medical castration (LHRH, GnRH agonist)
- palliative care
