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Urology YR3 > Prostate cancer > Flashcards

Prostate cancer Flashcards

1
Q

Pathophys prostate cancer

A
  • Growth of prostate influenced by androgens
  • Majority are adenocarcinoma - exact cause unknown
  • Most arise from peripheral zone
  • Often multifocal
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2
Q

Two types of prostate adenocarcinomas

A
  • Acinar - originates from glandular cells that line prostate gland, most common
  • Ductal - originates from cells that line the ducts of prostate gland, grows and metastasise further than acinar adenocarcinomas
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3
Q

Main RF for prostate cancer

A
  • Age
  • Ethnicity - Black African or Caribbean
  • FH of prostate cancer
  • Genetics - BRCA1 or 2 mutation
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4
Q

Other less significant modifiable RF for prostate cancer

A
  • Obesity
  • Diabetes
  • Smoking - increased risk of prostate cancer death
  • Degree of exercise
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5
Q

Symptoms of prostate cancer

A

Localised: LUTS
* Weak stream
* Frequency
* Urgency

Advanced localised:
* Haematuria
* Dysuria
* Incontinence
* Haematospermia
* Suprapubic pain
* Loin pain
* Rectal tenesmus

Metastatic:
* Bone pain
* Lethargy
* Anorexia
* Unexplained weight loss

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6
Q

DRE for prostate cancer

A
  • Essential as most arise from posterior peripheral zone
  • Assymetry?
  • Nodularity?
  • Fixed, irregular mass?
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7
Q

What is PSA?

A
  • Prostate specific antigen
  • Serum protein produced by malignant and healthy cells of prostate gland
  • Can be elevated secondary to cancer
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8
Q

Other conditions, other than malignancy, that can elevate PSA

A
  • BPH
  • Prostatitis
  • UTI
  • Recent urological surgery
  • Urinary retention
  • DRE - can raise but thought to be <0.3ng/mL so should not affect interpretation
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9
Q

What further calculations can be done using PSA?

A
  • Free:total PSA ratio - used to increase accuracy of PSA 4-10
  • Low free:total ratio is associated with increased chance of diagnosing prostate cancer
  • PSA density - serum PSA level divided by prostate volume identified on imaging
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10
Q

Prostate cancer screening?

A
  • No national screening program
  • Research needed into determining benefit of widespread screening, overdiagnosis and overtreatment
  • If offered PSA screening test, need counselling prior to test
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11
Q

First line imaging for suspected prostate cancer (re PSA or DRE findings)

A
  • Multi-parametric MRI scan of prostate
  • Identifies abnormal areas which can be targeted for biopsy

Multiparametric - several different MRI techniques combined

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12
Q

Two biopsy options for prostate

A
  • Transperineal - most common, less risk of infection
  • Transrectal US guided biopsy (TRUS)
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13
Q

Transperineal biopsy

A
  • Via template biopsy using grid like template, sampling in systematic manner
  • OR free hand biopsy where sampling guided by intraprocedure US and mpMRI
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14
Q

TRUS biopsy

A
  • Sample of prostate transrectally
  • Using USS as guidance then sampling in systematic manner
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15
Q

What to do if previous negative biopsy but persistent raised PSA or suspicious DRE?

A

Repeat biopsy

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16
Q

Histological grading of prostate cancer

A
  • Gleason grading
  • Based on histological appearance
  • Assigned to score according to differentiation
  • Gleason score is then most common growth pattern + 2nd most common growth pattern
17
Q

Lowest gleason score

A
  • 3+3
  • Higher scores = poorer prognosis
18
Q

Determining prognosis of prostate cancer

A
  • Gleason score
  • TNM
  • PSA levels
19
Q

Gleason scoring

A
20
Q

Imaging for staging prostate cancer

A
  • Done in intermediate or high risk disease
  • CT chest abdomen pelvis AND PET-CT nuclear medicine scan
21
Q

Management of localised prostate cancer

A
  • Relates to risk stratification based on PSA levels, Gleason score and T staging (from TNM)
  • Low, intermediate and high
22
Q

Risk stratification NICE localised prostate cancer values

A
23
Q

Management of low risk localised prostate cancer

A
  • Active surveillance
  • Radical treatments offered to those who show disease progression
24
Q

Management of intermediate and high risk disease

A
  • Radical treatments discussed with all men with intermediate risk and high risk with realistic disease control
  • Intermediate can also be offered active surveillance
25
Q

Management of metastatic disease

A
  • Chemotherapy
  • Antihormonal agents
26
Q

Management castrate resistant disease

A
  • Further chemotherapy agents eg Docetaxel
  • Corticosteroids 3rd line (after androgen deprivation and anti-androgen therapy with hormone relapsed cancer)
27
Q

What does active surveillance of prostate cancer entail?

A
  • 3 monthly PSA
  • 6 month DRE
  • Re-biopsy at 1-3 yearly intervals assessing for progression
  • mpMRI also increasingly being used
  • Intervening at appropriate time
28
Q

What is ‘watchful waiting’?

A
  • Symptom guided approach
  • Therapy is deferred and initiated at a time of symptomatic disease, intent is NOT curative
  • Offered for older patients with lower life expectancy usually, can be offered at any stage, no predefine f/u, management guided by patient goals
29
Q

Main surgical management prostate cancer

A
  • Radical prostatectomy - open, laparascopic or robotically
  • Removal of prostate gland, resection of seminal vesicles along with surrounding tissue +/- dissection of pelvic lymph nodes
30
Q

Side effects of radical prostatectomy

A
  • Erectile dysfunction
  • Stress incontinence
  • Bladder neck stenosis
31
Q

Alternative curative therapies for localised prostate cancer

A
  • Radiotherapy - external beam and brachytherapy
32
Q

What does brachytherapy involve?

A

Transperineal implantation of radioactive seeds directly into prostate gland

33
Q

What is external beam radiotherapy?

A
  • Focused radiotherapy targetted to the prostate gland
  • Limiting damage to surrounding tissues
34
Q

Anti-androgen therapy for prostate cancer - how does it help?

A

Prostate cancer cells undergo apoptosis when deprived of testosterone

35
Q

Options for anti-androgen therapy

A
  • Anti-androgens - Bicalutamide
  • Gonadotrophin releasing hormone receptor (GnRH) agonists - Goserelin
  • GnRH antagonists - Degarelix
  • Surgical castration
  • Newer hormone therapies - Enzalutamide, Abiraterone
36
Q

Chemotherapy used in metastatic prostate cancer

A

Docetaxel or Cabazitaxel

Urology YR3 (27 decks)

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