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Y3 - Renal > Prostate cancer > Flashcards

Prostate cancer Flashcards

1
Q

What percent does prostate cancer represent all new male cancer cases?

A

25%

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2
Q

What is the 5 year survival rate percentage?

A

98%

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3
Q

What is the prostate gland?

A

a walnut-sized gland located between the bladder neck and the external urethral sphincter

the prostatic urethra runs directly through the prostate, emerging as the membranous and penile urethra.

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4
Q

What are the 4 zones of the prostate gland?

A
  1. The peripheral zone (posteriorly)
  2. The fibromuscular zone (anteriorly)
  3. The central zone (centrally)
  4. the transitional zone (surrounding the urethra)
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5
Q

What is the inferior portion of the prostate termed?

A

Apex

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6
Q

Name 5 risk factors for prostate cancer?

A
  1. Age >50
  2. Black ethnicity
  3. Family history
  4. Family history of other hereditary cancer
  5. High levels of dietary fat
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7
Q

What is the most common presenting symptom of prostate cancer?

A

Lower urinary tract symptoms such as frequency, urgency, nocturia, hesitancy, dysuria and post-void dribbling

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8
Q

Name 4 other symptoms of prostate cancer?

A
  1. Haematuria
  2. Haematospermia
  3. Systemic symptoms: weight loss, weakness, fatigue
  4. Bone pain (associated metastatic prostate cancer)
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9
Q

What is Haematospermia?

A

Haematospermia is the medical term for blood in the semen.

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10
Q

What 3 things should be looked for on examination?

A
  1. Asymmetrical prostate
  2. Nodular prostate
  3. Indurated prostate
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11
Q

What should a DRE always be accompanied by?

A

PSA test
*DRE may only detect tumours that are present in the posterior and lateral aspects of the prostate gland as these are often the only palpable regions; therefore DRE should always be accompanied by a PSA test (more below).Conversely, there will be patients with prostate cancer who have normal PSA levels and an abnormal DRE. It is, therefore, crucial that both are performed in suspected cases.

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12
Q

Name 3 differentials for prostate cancer?

A
  1. BPH
  2. Chronic prostatitis
  3. Urethral instrumentation
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13
Q

How does BPH differentiate from prostate cancer?

A

DRE reveals benign-feeling, enlarged prostate, with no obvious nodules

Biopsy would differentiate between BPH and malignancy

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14
Q

How does chronic prostatitis differentiate from prostate cancer?

A

Symptoms develop over 3 months to 1 year
Microscopy of prostate secretions reveal leukocytes and inflammation
PSA is normally only mildly elevated
Treatment with antibiotics can be trialled if there is a high degree of clinical suspicion

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15
Q

How does urethral instrumentation differentiate from prostate cancer?

A

History of recent intervention can lead to temporary elevation of PSA

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16
Q

What PSA result indicate a 2-week referral?

A

Normal PSA levels are age-specific. In the UK, Public Health England recommends 2-week referral for men aged 50-69 years old with a PSA ≥3ng/ml and for men aged 70+ with a PSA >5ng/ml

Note: PSA can be raised by prostatitis, BPH or UTI, leading to a higher baseline. Therefore, it may be important to repeat the PSA to confirm trending elevation.

17
Q

What may U&Es reveal in prostate cancer?

A

Cancer may be obstructing ureters, leading to hydronephrosis and kidney dysfunction.

18
Q

What would a full blood count show in prostate cancer?

A

Anaemia

19
Q

What further investigations can be performed?

A
  1. Multiparametric MRI
  2. Biopsy
20
Q

What grading system is used when assessing prostate biopsies?

A

Gleason grading system

21
Q

What is tumour grade one and the corresponding Gleason score?

A

≤6
Low-grade tumour, sometimes “clinically insignificant”

22
Q

What is tumour grade two and the corresponding Gleason score?

A

7 (3+4)
Intermediate-grade tumour. More favourable outcome than 4+3

23
Q

What is tumour grade four and the corresponding Gleason score?

A

8
High-Grade tumour

24
Q

What is tumour grade three and the corresponding Gleason score?

A

7 (4+3)
Intermediate-grade tumour. Less favourable outcome than 3+4

25
Q

What is tumour grade five and the corresponding Gleason score?

A

9-10
highest grade tumour

26
Q

What is the prostate cancer screening protocol?

A

At present, there is no formal screening program for prostate cancer in the UK. However, men >50 years old are eligible to request a PSA test, following discussions with their GP about the pros and cons

27
Q

What is the management plan for low-risk prostate cancer?

A

Low risk = PSA <10ng/ml + Gleason score ≤6 + clinical stage T1-2a
- Watchful waiting
- Active surveillance (intent for curative treatment, but delayed)

28
Q

What is the management plan for intermediate risk of prostate cancer?

A

Intermediate risk = PSA 10-20ng/ml OR Gleason score 7 OR T2b stage

  • Active surveillance
  • Radical prostatectomy (total removal of the prostate through open, laparoscopic or robotic-assisted approaches. Used for T1-T3 tumours in patients with a life expectancy of greater than 10 years.)
  • Radiotherapy
29
Q

What are the two types of radiotherapy that is used for intermediate risk prostate cancer?

A

External-beam radiotherapy (EBRT): beams of radiation are targeted to cancer cells in the prostate. Therapy is typically given for 7-8 weeks. Used for T1-3 tumours.

Brachytherapy: an innovative form of radiotherapy for prostate cancer, brachytherapy involves the permanent implantation of small balls of radioactive material into the prostate gland. Radiation is constantly provided in order to shrink tumour cells. Used for localised T1-2 tumours with a Gleason score of 7, PSA <20ng/ml and life expectancy greater than 5 years.

30
Q

What is the management plan for high risk prostate cancer?

A
  1. External-beam radiotherapy
  2. GnRH therapy
  3. Androgen receptor antagonists
  4. Androgen blocker targeting the adrenal glands
  5. Bilateral orchiectomy
  6. Oestrogen
31
Q

What is GnRH therapy?

A
  1. GnRH antagonists competitively bind GnRH receptors in the anterior pituitary, resulting in a decrease in testosterone
  2. GnRH agonists active GnRH receptors over a prolonged period of time, leading to desensitization and decreased androgen secretion.
  3. Starving the prostate of androgens will result in shrinkage of the gland and the associated malignancy.
32
Q

What is androgen receptor antagonists?

A

(e.g. bicalutamide, flutamide): this class of medication blocks cancerous androgen receptors, leading to decreased androgen-driven malignant growth.

33
Q

What are androgen blockers targeting the adrenal glands?

A

androgens are also formed in the adrenal glands and can be blocked from release using medications such as abiraterone and ketoconazole.

34
Q

What is a bilateral orchiectomy?

A

removal of the testicles starves the prostate gland of testosterone.

35
Q

Name 5 side effects of hormone therapy?

A
  1. Hot flushes
  2. Decrease bone density
  3. Fractures
  4. Low libido
  5. Erectile dysfunction
36
Q

Name 5 complications of radical treatment for prostate cancer?

A
  1. Dysuria
  2. Urinary frequency
  3. Urinary incontinence
  4. Rectal bleeding
  5. Erectile dysfunction

Y3 - Renal (13 decks)

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