Prostate cancer Flashcards
Risk factors for prostate cancer
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
Initial genetic mutations genes
oncogenes (e.g., MYC, ERG) and tumour suppressor genes (e.g., TP53, PTEN).
what causing clonal expansion of caner cells
hormones (e.g., androgens), growth factors (e.g., IGF-1), and inflammatory mediators (e.g., IL-6).
What genetic mutations in final stage selective advantage for invading tissues and resisting apoptosis
PI3K/AKT/mTOR, MAPK, and Wnt signalling pathways.
Clinical features of prostate cancer
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
When refer for suspected prostate cancer
Prostate feels malignant on PR exam
PSA above normal levels
When consider a PSA test and PR exam for prostate cance r
Any lower urinary symptoms eg nocturia, urinary frequency, hesitancy, urgency or retnetion or
Erectile dysfunciton
Visible haematuria
Investigaiton for prostate cancer
NICE first line= multiparametric MRI as first line
(was US TRUS biopsy)
TRUS biopsy complications
sepsis: 1% of cases
pain: lasting >= 2 weeks in 15% and severe in 7%
fever: 5%
haematuria and rectal bleeding
What determines whether do a biospy for prostate cancer
Likhert scale 1-5 from multiparametric MRI
What likhert scale means offer biopsy vs discuss pros and cons
> 3 -> biopsy
1-2 = discuss
Localised prostate cancer T1/2 management
Watch and wait - active monitoring
Radical prostatectomy
Radiotherapy - external beam and brachytherapy
Localised advanced prostate cancer (T3/T4)) managmenet
Hormonal therap
Radical prostatectomy
Radiotherapy
What chemo is used in prostate cancer
Docetaxel
antiandrogen therapy options in prostate cancer
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
Risks with radical prostatectomy
Erectile dysfunction common complication
Radiotherapy side effects in prostate cancer
Proctitis
Increased risk of bladder, colon and rectal cacner
How do GnRH agonist/antagonsits MOA prostate cancer
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
Why need to prescribe an anti androgen with GnRH agonsits
prevent a rise in testosterone - ‘tumour flare’. The resultant stimulation of prostate cancer growth may result in bone pain, bladder obstruction and other symptoms
prognosis prostate cancer 5 year survivalrates
99% and 96% localised and regional (III)
IV /distant mets = 30%
Factors affecting prognosis prostate cancer
Stage
Fleason score - how aggresisive cancer is 1-10
PSA level
Age and health
PSA age related limits recommended
NICE - >3 aged 50-69 or abnormal DRE
>4 for 60-60
>5 for 70
What can raise PSA levels
BPH
Prostatits and UTI
Ejaculation - ideally not in last 48 hrs
Vigorous exercise - as above
Urinary retention
iNSTRUMENTATation of unrinary tract eg catheter
Sensitivity and specificity of PSA
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)
