Prostate cancer Flashcards
True or false: prostate cancer is the most common cancer in men
True
Advanced prostate cancer most commonly spreads to the ______ ____ and ____
lymph nodes and bones (thick sclerotic lesions)
Also to liver, lung and brain
Prostate cancer is almost always a_____-dependent as they rely on a_____ hormones to grow
androgen
The majority of prostate cancers are __________ (type of cancer) and grow in the peripheral zone of the prostate
adenocarcinomas
What are risk factors for prostate cancer
Age
Family history
Black African or Caribbean origin
Tall stature
Anabolic steroids
What genes are associated with prostate cancer?
BRCA2 and HOXB13
Prostate cancer may be asymptomatic or may present with lower _____ ___ symptoms like benign prostate hyperplasia
urinary tract
What are some lower urinary tract symptoms?
Hesitancy
Frequency
Weak flow
Terminal dribbling
Nocturia
What are some other non-lower urinary tract symptoms of prostate cancer?
Haematuria
Erectile dysfunction
Symptoms of advanced disease / metastasis:
weight loss
Bone pain
Cauda equina syndrome
Epithelial cells of the prostate release p____-s____ a_____ which is a glycoprotein.
prostate-specific antigen (PSA)
PSA is secreted in the _____ with small amount entering the blood
semen
True of false: PSA’s enzymatic activity helps to thicken the semen after ejaculation
False
It helps to thin the thick semen into a liquid consistency after ejaculation
True or false: a raised level of PSA can indicate potential prostate cancer
True
Is PSA testing reliable for screening?
Has a high rate of false positives (75%) and false negatives (15%)
What else can cause raised PSA levels?
Benign prostatic hyperplasia
Prostatitis
UTIs
Vigorous exercise, especially cycling
Reject ejaculation or prostate stimulation
A prostate exam is performed during a d___ r___ examination
digital rectal
How does a benign prostate feel?
Smooth, symmetrical and slightly soft with a maintained central sulcus (dip between the 2 lobes).
In hyperplasia, may be generalised enlargement.
How may an infected of inflamed prostate feel?
May be enlarged, tender and warm
How may a cancerous prostate feel?
Firm or hard and asymmetrical, craggy or irregular.
Loss of central sulcus
Possible hard nodule
What are the next steps after finding a potential prostate cancer from an examination?
2 week wait referral to urology
What is the first line investigation for suspected localised prostate cancer?
Multiparametric MRI
What is the Likert scale?
Scale 1-5 to rate how likely it is a cancer
1 = very low suspicion
5 = definite cancer
After taking a multiparametric MRI, what is the next stage in investigation?
Prostate biopsy (however risk of false-negative if biopsy misses cancerous area)
What are the 2 options for prostate biopsy?
Transrectal ultrasound-guided biopsy (TURS, through rectum into prostate)
or
Transperineal biopsy (through skin behind testicles)
What are the main risks of a prostate biopsy?
Pain
Bleeding (stools, urine or semen)
Infection
Urinary retention (due to short term swelling of prostate)
Erectile dysfunction
What imaging can be used to look for bony metastasis?
An isotope bone scan (also called radionuclide scan)
How does an isotope bone scan work?
IV injection of radioactive isotope
Wait 2-3 hours
Bone takes up isotope
metastatic bone lesions take up more of isotope
Gamma camera takes picture of skeleton
Lesions stand out more on scan
What grading system is used from the prostate biopsies and is used to determine treatment?
Gleason grading system (2 number added together for total score)
What do the 2 numbers of the Gleason score indicate?
First number is the grade of the most prevalent pattern in the biopsy
Second number is grade of second most prevalent pattern in biopsy
Score of:
6 = low risk
7 = intermediate risk
8+ = high risk
What treatment is available for prostate cancer?
Surveillance in early stage
External beam radiotherapy
Brachytherapy
Hormone therapy
Surgery
What is a complication of external beam radiotherapy?
Proctitis, inflammation in the rectum causing pain, altered bowel habit or rectal bleeding and discharge
What is brachytherapy?
Implanting radioactive metal “seeds” into the prostate to deliver continuous targeted radiotherapy
True or false: prostate cancer is the most hormone sensitive cancer
True
