Prostate cancer Flashcards
Prostate cancer pathophysiology
Growth of prostate cancer is influenced by androgens
Prostate cancer types
Majority are adenocarcinomas
- > 75% of adenocarcinomas arise from the peripheral zone, 20% in the transitional zone & 5% central zone
- Acinar adenocarcinoma - originates in the glandular cells that line the prostate gland (most common)
- Ductal adenocarcinoma - originates in the cells that line the ducts of the prostate gland (tends to grow & metastasise faster than acinar adenocarcinoma)
Other types include small cell, squamous cell, transitional cell carcinoma
Prostate cancer risk factors
Age - incidence of prostate cancer increases with age
Ethnicity - men of black African/Caribbean ethnicity
Family history of prostate cancer
Genetic predisposition - BRCA2/BRCA1 gene
Modifiable risk factors - obesity, diabetes mellitus, smoking
Prostate cancer clinical features
LUTS - weak urinary stream, increased urinary frequency & urgency
More advanced localised disease → haematuria, dysuria, incontinence, haematospermia, suprapubic pain, loin pain & rectal tenesmus
Bone pain
Lethargy
Anorexia
Unexplained weight loss
Prostate cancer Ix
DRE
PSA
Multi-parametric MRI scan of prostate
Biopsy
- transperineal biopsy - preferred due to decreased risk of infection
- transrectal biopsy
Staging - CT C/A/P and PET-CT
Prostate cancer grading
Gleason grading system
Sample of prostate tissue is assigned a score according to its differentiation & Gleason score is calculated from this
Higher Gleason, poorer prognosis
Used is conjunction with PSA levels & TNM staging
Prostate cancer general management
Discussion at a specialist prostate cancer MDT
Low-risk disease - active surveillance, radical treatments offered to those who show evidence of disease progression
Intermediate & high risk disease - radical treatment options (low intermediate can be offered active surveillance)
Metastatic disease - chemotherapy & anti-hormonal agents can be used
Castrate-resistant disease - evidence of hormone-relapsed disease patients can be considered for further chemo, corticosteroids can be offered as a third-line hormonal therapy
Prostate cancer watchful waiting & active surveillance
Watchful waiting - symptom-guided approach to prostate cancer management where therapy is deferred & initiated at time of symptomatic disease; intent not curative
Active surveillance - can be offered to select patients with curable low-risk disease
- 3-monthly PSA, 6 month to yearly DRE, re-biopsy at 1-3 yearly intervals assessing for progression
Prostate cancer surgical management
Radical prostatectomy - open, laparoscopically or robotically
SE: ED, stress incontinence & bladder neck stenosis
Prostate cancer radiotherapy
External-beam radiotherapy - focused radiotherapy to target the prostate gland & limiting damage to surrounding tissues
Brachytherapy - transperineal implantation of radioactive seeds directly into the prostate gland
Prostate cancer anti-androgen therapy & chemotherapy
Androgen deprivation therapy - mainstay of management of metastatic prostate cancer & improves outcomes in patients undergoing radiotherapy
- anti-androgens
- GnRH receptor agonists (goserelin)
- GnRH receptor antagonists (degarelix)
- surgical castration
Chemo is only indicated in metastatic disease