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YR6: Renal + Urology > Prostate cancer > Flashcards

Prostate cancer Flashcards

1
Q

What is prostate cancer?

A

Malignant tumour of the prostate
95% Adenocarcinomas

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2
Q

Describe the nature of prostate cancer growth

A

Mostly indolent + slow growing
Minority are aggressive + invade local structure/ metastasise

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3
Q

Describe prevalence of prostate cancer in the UK

A

Most common cancer in men
2nd most common cause of cancer death in men

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4
Q

List 4 risk factors for prostate cancer?

A

Age >50
Black/ Afro-caribbean ethnicity
FH
Obesity

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5
Q

Describe onset of prostate cancer

A

Often ASYMPTOMATIC (esp. localised as tend to develop in periphery of prostate + don’t cause obstructive Sx early on)

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6
Q

List 7 symptoms of prostate cancer caused by bladder outlet obstruction

A

Frequency
Urgency
Hesitancy
Poor stream
Terminal dribbling
Nocturia
Dysuria

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7
Q

List 3 general symptoms of prostate cancer

A

Haematuria/ Haematospermia
Lethargy
Pain: back, perineal, testicular

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8
Q

List 3 symptoms of advanced prostate cancer

A

Lower back pain
Bone pain
Weight loss

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9
Q

Describe possible DRE findings in prostate cancer

A

Asymmetrical hard nodular enlargement with loss of median sulcus

May feel normal, does NOT r/o tumour

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10
Q

What is the normal upper limit for PSA?

A

4 nanograms/ml
(though varies with age + race)

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11
Q

List 4 causes of false positive PSA result

A

Prostatitis
UTI
BPH
Vigorous DRE

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12
Q

What should people NOT have before PSA testing?

A

An active UTI or within previous 6w.
Ejaculated in previous 48h.
Exercised vigorously, e.g. cycling, in previous 48h.
Had a urological intervention e.g. prostate biopsy in previous 6w.

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13
Q

When should PSA testing be utilised?

A

Consider in those with suspected prostate cancer
Offered to >50s who request PSA

NOT to asymptomatic people

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14
Q

When should 2ww referal be made in suspected prostate cancer?

A

If prostate feels malignant on DRE
If Sx + raised PSA

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15
Q

What is the firstline investigation for prostate cancer? How are results reported?

A

Multiparametric MRI
Results reported on 5-point Likert scale

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16
Q

How are results of multiparametric MRI for prostate cancer acted upon?

A

> 3: multiparametric MRI-influenced prostate biopsy

1-2: pros + cons of biopsy discussed

17
Q

What investigation used to be first line for suspected prostate cancer?

A

Transrectal Ultrasound guided (TRUS) Biopsy

18
Q

List 4 complications of TRUS

A

Sepsis (1%)
Pain >2w
Fever
Haematuria + rectal bleeding

19
Q

What system is used for grading prostate cancer?

A

Gleason grading system

20
Q

Where does prostate cancer spread to first?

A

Lymphatic spread to obturator nodes
Local extra prostatic spread to seminal vesicles

21
Q

In which patients may a watch and wait approach be taken?

A

Elderly
Multiple co-morbidities
Low Gleason score

22
Q

Describe the management options for localised prostate cancer (T1/T2)

A

Conservative: active monitoring + watchful waiting
Radical prostatectomy
Radiotherapy

23
Q

Describe the management options for localised advanced prostate cancer (T3/T4)

A

Hormonal therapy
Radical prostatectomy
Radiotherapy

24
Q

Describe management options for metastatic prostate cancer

A

Hormone therapy
Radiotherapy
Chemotherapy

25
Q

How can radiotherapy be delivered in prostate cancer?

A

External beam
Brachytherapy

26
Q

Name a common complication of radical prostatectomy

A

Erectile dysfunction

27
Q

Give 2 complications of radiotherapy for prostate cancer

A

Prostatitis
Increased risk bladder, colon + rectal carcinoma

28
Q

What is one of the key aims of treating advanced prostate cancer? What strategies can be used for this?

A

Reduce androgen levels
Anti-androgen therapy
Chemotherapy (Docetaxel)

29
Q

Name a surgical method to rapidly reduce testosterone levels

A

Bilateral orchidectomy

30
Q

Name 4 drugs that can be used to reduce androgen levels in prostate cancer

A

Synthetic GnRH agonists/ antagonists
Bicalutamide
Cyproterone acetate
Abiraterone

31
Q

Name a GnRH agonist and describe its use in prostate cancer

A

Goserelin (Zoladex)
Paradoxically result in lower LH levels long term by causing overstimulation

32
Q

What unwanted affect occurs when using GnRH agonists in prostate cancer? How can this be mitigated?

A

Testosterone initially rises for 2-3w before falling to castration levels
Use anti-androgen to prevent rise in testosterone ‘tumour flare’

33
Q

Name a GnRH antagonist and describe its use in prostate cancer

A

Degarelix
Suppress testosterone + avoid flare phenomenon

34
Q

What is Bicalutamide? How is this helpful in prostate cancer?

A

Non-steroidal anti-androgen
Blocks the androgen receptor

35
Q

What is Cyproterone acetate?

A

Steroidal anti-androgen

36
Q

What is Abiraterone? When is this used?

A

Androgen synthesis inhibitor
Tx of hormone-relapsed metastatic prostate cancer in those with no/ mild Sx after androgen deprivation failed + before chemo indicated

YR6: Renal + Urology (21 decks)

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