Prostate cancer

Question 1

Risk factors for prostate cancer

Answer 1

Age
Black african ethnicity, then caucasian and hispanic/ Asian and natice american men lower rates
FH and genetics
Hormonal factors
Environemantla factors - chemical exposure, high fat diet, sediantary, obsesity

Question 2

Initial genetic mutations genes

Answer 2

oncogenes (e.g., MYC, ERG) and tumour suppressor genes (e.g., TP53, PTEN).

Question 3

what causing clonal expansion of caner cells

Answer 3

hormones (e.g., androgens), growth factors (e.g., IGF-1), and inflammatory mediators (e.g., IL-6).

Question 4

What genetic mutations in final stage selective advantage for invading tissues and resisting apoptosis

Answer 4

PI3K/AKT/mTOR, MAPK, and Wnt signalling pathways.

Question 5

Clinical features of prostate cancer

Answer 5

Often asymptomatic as cancers tend to develop peripherally - dont cause obstruction
-bladder outlet obstruction - hesitancy, urinary retention
Haematuria, haemaatospermia
Pain - back, perineal or testicular
PR exam - asymetrical hard nodular enlargement with loss of median sulcus

Question 6

When refer for suspected prostate cancer

Answer 6

Prostate feels malignant on PR exam
PSA above normal levels

Question 7

When consider a PSA test and PR exam for prostate cance r

Answer 7

Any lower urinary symptoms eg nocturia, urinary frequency, hesitancy, urgency or retnetion or
Erectile dysfunciton
Visible haematuria

Question 8

Investigaiton for prostate cancer

Answer 8

NICE first line= multiparametric MRI as first line
(was US TRUS biopsy)

Question 9

TRUS biopsy complications

Answer 9

sepsis: 1% of cases
pain: lasting >= 2 weeks in 15% and severe in 7%
fever: 5%
haematuria and rectal bleeding

Question 10

What determines whether do a biospy for prostate cancer

Answer 10

Likhert scale 1-5 from multiparametric MRI

Question 11

What likhert scale means offer biopsy vs discuss pros and cons

Answer 11

> 3 -> biopsy
1-2 = discuss

Question 12

Localised prostate cancer T1/2 management

Answer 12

Watch and wait - active monitoring
Radical prostatectomy
Radiotherapy - external beam and brachytherapy

Question 13

Localised advanced prostate cancer (T3/T4)) managmenet

Answer 13

Hormonal therap
Radical prostatectomy
Radiotherapy

Question 14

What chemo is used in prostate cancer

Answer 14

Docetaxel

Question 15

antiandrogen therapy options in prostate cancer

Answer 15

Synthetic GnRH agonist or antagonist eg goserelin, zoladex
Bicalutamide - non steroid anti androgen
Cyproterone acetate - steroidal above
Abiraterone - androgen synthesis inhibitor
Bilateral orchidectomy to reduce testosterone levels rapidly

Question 16

Risks with radical prostatectomy

Answer 16

Erectile dysfunction common complication

Question 17

Radiotherapy side effects in prostate cancer

Answer 17

Proctitis
Increased risk of bladder, colon and rectal cacner

Question 18

How do GnRH agonist/antagonsits MOA prostate cancer

Answer 18

Reduce testosterone levels
paradoxically result in lower LH levels longer term by causing overstimulation, resulting in disruption of endogenous hormonal feedback systems. The testosterone level will therefore rise initially for around 2-3 weeks before falling to castration levels

Question 19

Why need to prescribe an anti androgen with GnRH agonsits

Answer 19

prevent a rise in testosterone - ‘tumour flare’. The resultant stimulation of prostate cancer growth may result in bone pain, bladder obstruction and other symptoms

Question 20

prognosis prostate cancer 5 year survivalrates

Answer 20

99% and 96% localised and regional (III)
IV /distant mets = 30%

Question 21

Factors affecting prognosis prostate cancer

Answer 21

Stage
Fleason score - how aggresisive cancer is 1-10
PSA level
Age and health

Question 22

PSA age related limits recommended

Answer 22

NICE - >3 aged 50-69 or abnormal DRE
>4 for 60-60
>5 for 70

Question 23

What can raise PSA levels

Answer 23

BPH
Prostatits and UTI
Ejaculation - ideally not in last 48 hrs
Vigorous exercise - as above
Urinary retention
iNSTRUMENTATation of unrinary tract eg catheter

Question 24

Sensitivity and specificity of PSA

Answer 24

Poor
around 33% of men with a PSA of 4-10 ng/ml will be found to have prostate cancer. With a PSA of 10-20 ng/ml this rises to 60% of men
around 20% with prostate cancer have a normal PSA
various methods are used to try and add greater meaning to a PSA level including age-adjusted upper limits and monitoring change in PSA level with time (PSA velocity or PSA doubling time)