Prostate cancer Flashcards
What is prostate cancer?
Malignant tumour of the prostate
95% Adenocarcinomas
Describe the nature of prostate cancer growth
Mostly indolent + slow growing
Minority are aggressive + invade local structure/ metastasise
Describe prevalence of prostate cancer in the UK
Most common cancer in men
2nd most common cause of cancer death in men
List 4 risk factors for prostate cancer?
Age >50
Black/ Afro-caribbean ethnicity
FH
Obesity
Describe onset of prostate cancer
Often ASYMPTOMATIC (esp. localised as tend to develop in periphery of prostate + don’t cause obstructive Sx early on)
List 7 symptoms of prostate cancer caused by bladder outlet obstruction
Frequency
Urgency
Hesitancy
Poor stream
Terminal dribbling
Nocturia
Dysuria
List 3 general symptoms of prostate cancer
Haematuria/ Haematospermia
Lethargy
Pain: back, perineal, testicular
List 3 symptoms of advanced prostate cancer
Lower back pain
Bone pain
Weight loss
Describe possible DRE findings in prostate cancer
Asymmetrical hard nodular enlargement with loss of median sulcus
May feel normal, does NOT r/o tumour
What is the normal upper limit for PSA?
4 nanograms/ml
(though varies with age + race)
List 4 causes of false positive PSA result
Prostatitis
UTI
BPH
Vigorous DRE
What should people NOT have before PSA testing?
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.
When should PSA testing be utilised?
Consider in those with suspected prostate cancer
Offered to >50s who request PSA
NOT to asymptomatic people
When should 2ww referal be made in suspected prostate cancer?
If prostate feels malignant on DRE
If Sx + raised PSA
What is the firstline investigation for prostate cancer? How are results reported?
Multiparametric MRI
Results reported on 5-point Likert scale
How are results of multiparametric MRI for prostate cancer acted upon?
> 3: multiparametric MRI-influenced prostate biopsy
1-2: pros + cons of biopsy discussed
What investigation used to be first line for suspected prostate cancer?
Transrectal Ultrasound guided (TRUS) Biopsy
List 4 complications of TRUS
Sepsis (1%)
Pain >2w
Fever
Haematuria + rectal bleeding
What system is used for grading prostate cancer?
Gleason grading system
Where does prostate cancer spread to first?
Lymphatic spread to obturator nodes
Local extra prostatic spread to seminal vesicles
In which patients may a watch and wait approach be taken?
Elderly
Multiple co-morbidities
Low Gleason score
Describe the management options for localised prostate cancer (T1/T2)
Conservative: active monitoring + watchful waiting
Radical prostatectomy
Radiotherapy
Describe the management options for localised advanced prostate cancer (T3/T4)
Hormonal therapy
Radical prostatectomy
Radiotherapy
Describe management options for metastatic prostate cancer
Hormone therapy
Radiotherapy
Chemotherapy
How can radiotherapy be delivered in prostate cancer?
External beam
Brachytherapy
Name a common complication of radical prostatectomy
Erectile dysfunction
Give 2 complications of radiotherapy for prostate cancer
Prostatitis
Increased risk bladder, colon + rectal carcinoma
What is one of the key aims of treating advanced prostate cancer? What strategies can be used for this?
Reduce androgen levels
Anti-androgen therapy
Chemotherapy (Docetaxel)
Name a surgical method to rapidly reduce testosterone levels
Bilateral orchidectomy
Name 4 drugs that can be used to reduce androgen levels in prostate cancer
Synthetic GnRH agonists/ antagonists
Bicalutamide
Cyproterone acetate
Abiraterone
Name a GnRH agonist and describe its use in prostate cancer
Goserelin (Zoladex)
Paradoxically result in lower LH levels long term by causing overstimulation
What unwanted affect occurs when using GnRH agonists in prostate cancer? How can this be mitigated?
Testosterone initially rises for 2-3w before falling to castration levels
Use anti-androgen to prevent rise in testosterone ‘tumour flare’
Name a GnRH antagonist and describe its use in prostate cancer
Degarelix
Suppress testosterone + avoid flare phenomenon
What is Bicalutamide? How is this helpful in prostate cancer?
Non-steroidal anti-androgen
Blocks the androgen receptor
What is Cyproterone acetate?
Steroidal anti-androgen
What is Abiraterone? When is this used?
Androgen synthesis inhibitor
Tx of hormone-relapsed metastatic prostate cancer in those with no/ mild Sx after androgen deprivation failed + before chemo indicated
