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Adult Health Issues + Men's Health > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

what is the most common cause of cancer in men in australia

A

prostate cancer

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2
Q

prostate cancer is the x most common cause of cancer death in men

A

2nd

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3
Q

prostate cancer average age of diagnosis

A

69yo

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4
Q

does prostate cancer have a good prognosis?

what is the 5 year survival rate?

A
  • generally good prognosis
  • 5 year survival rate of 96%
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5
Q

types of cancer in prostate cancer

A
  • adenocarcinoma (malignant)
  • urothelial cancer
  • squamous cell carcinoma (malignant)
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6
Q

pathogenesis of prostate cancer

A
  • acquired genetic mutation (like all cancers)
    ie/ rate of cell division exceeds rate of cell death
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7
Q

urothelial cancer arises from

A

urothelial lining of the prostate urethra

(urothelium = lines inside of urinary tract)

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8
Q

risk factors of prostate cancer (4)

A
  • age (older)
  • family history of prostate cancer
  • genetic mutations( (BRCA2)
  • race (african american>caucasian>asian and hispanic)
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9
Q

presentation of early prostate cancer can be ____, usually detected by ____

A
  • asymptomatic
  • screening
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10
Q

(2) symptoms of locally advanced prostate cancer

A
  • obstructive or irritative urinary symptoms (eg/ polyuria, dysuria, feelings of incomplete voiding, nocturia)
  • blood in urine (haematuria) or semen
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11
Q

(4) symptoms of metastatic prostate cancer

A
  • back or bone pain
  • leg swelling
  • weight loss
  • fatigue
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12
Q

list 3 presentations of prostate cancer

A
  • early prostate cancer
  • locally advanced prostate cancer
  • metastatic prostate cancer
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13
Q

(4) investigation options regarding prostate cancer

A
  • prostate specific antigen (PSA) - most common
  • free-to-total PSA
  • MRI
  • prostate biopsy
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14
Q

prostate specific antigen (PSA) is used for what

A

prostate cancer screening

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15
Q

list a consideration for interpretation of PSA levels

A
  • levels go up as people get older - normal ranges change in age grps
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16
Q

speed of level increase in PSA can also be indicative of

A

prostate cancer
(level increasing quickly)

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17
Q

high or low PSA level indicates prostate cancer

A

high level

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18
Q

if patient has been referred to a specialist for high PSA, they may also be looking at doing….

A

MRI

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19
Q

free to total PSA may be done depending on (2) and will provide ___ ____

A
  • age
  • PSA level
  • extra information
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20
Q

MRI has _____ amount of prostate biopsy done
but can also help to _____ biopsy

A
  • reduced
  • plan
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21
Q

from prostate biopsy, can get ____ ____

A

Gleason Score

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22
Q

what is Gleason Score

A
  • part of prostate cancer workup
  • grading system: measure for how aggressive the prostate cancer is
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23
Q

how is Gleason Score calculated

A
  • by looking at the 2 most common populations of cells for how abnormal they look compared to normal prostate tissue
  • then they are each scored & added together
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24
Q

Gleason Score - graded from -

A

1-5

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25
Q

Gleason Score ranking of 1 is

A
  • lowest score
  • represents well differentiated cells
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26
Q

Gleason Score ranking of 5 is

A
  • highest score
  • represents poorly differentiated cells
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27
Q

Gleason Score of 5 or less is considered

A

no longer cancer

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28
Q

Gleason Score of 6 and above is considered

A

prostate cancer

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29
Q

Gleason Score report provides which numbers and why

A

components of score (2) & total score
- first number: cell group that is most populous
therefore 3 + 4 is better than 4 + 3

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30
Q

treatment approach to prostate cancer - watchful waiting is a ___-________ approach

A

non-curative

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31
Q

indications for watchful waiting treatment

A
  • low risk prostate cancer
  • life expectancy <7years (generally due to other issues with their health)
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32
Q

low risk prostate cancer is a Gleason Score of

A

6

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33
Q

process of watchful waiting (monitoring method & frequency)

A
  • progress monitored by PSA
  • initially 3-4 monthly for 12 months then 6 monthly
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34
Q

treatment prostate cancer thats non-curative and not watchful waiting

A

active surveillance

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34
Q

indications for active surveillance

A

low risk prostate cancer

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35
Q

process of active surveillance (coordinated by whom, how is it monitored)

A
  • coordinated by urologist
  • combination of PSA testing, DRE, prostate MRI, prostate biopsy
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36
Q

for watchful waiting, what 2 things can occur indicative of __________ that prompt treatment initiation where they referred back to urologist for review and change treatment path

ie/ indicators for progression of disease

A
  • rapid rise PSA level
  • new symptoms
    evidence of progression of their prostate cancer
37
Q

rationale of active surveillance

A

most men with low risk prostate cancers. won’t die from their prostate cancer
curative treatment comes with side effects
this option for people not wanting curative treatment at this time
can be monitored for progression of their disease

38
Q

indicators of progression of disease for active surveillance
then can change approach when required

A

(same as watchful waiting)
- rapid rise PSA levels
- onset symptoms

39
Q

curative treatment of prostate cancer is

A

surgery - radical prostatectomy
radiotherapy

40
Q

surgery (radial prostatectomy) is recommended for which presentations of prostate cancer AND also what

A
  • localised or locally advanced prostate cancer
  • AND has life expectancy of at least 10 years
41
Q

complications of surgery (radical prostatectomy)

A
  • erectile dysfunction (ie/ nerve damage)
  • urinary incontinence (ie/ nerve damage)
  • urethral stricture (scarring that narrows urethra - tube that passes urine out of body)
  • change in ejaculation
  • infertility (due to disruption in connection to testicles)
42
Q

different approaches to surgery possible

A
  • open
  • laparoscopic
  • robot assisted (depending on specialist)
43
Q

why change in ejaculation from prostate removal surgery

A
  • prostate makes most of ejaculatory fluid
  • that fluid not going to be available
44
Q

2 types radiotherapy for prostate cancer

A
  • external beam radiotherapy
  • brachytherapy
45
Q

indications for external beam radiotherapy

A
  • localised or locally advanced prostate cancer if patient has life expectancy of at least 10 years
  • locally advanced disease which may benefit from multimodal therapy
  • rising / persistent PSA or established recurrence without metastasis following prostatectomy
  • patients with limited bone metastasis (to improve their survival ie/ palliative method)
46
Q

indications for brachytherapy

A
  • PSA <10
  • Gleason Score 6 or 7
  • small to moderate size prostate
  • low to intermediate grade prostate cancer
  • no previous prostate surgery
  • normal urine flow
47
Q

what is external beam radiotherapy

A

radiotherapy that is shot into patient externally

48
Q

what is brachytherapy

A

implant small radioactive seeds into prostate

49
Q

brachytherapy is ideal for those who

A
  • don’t want to undergo active surveillance
  • doesn’t want or not appropriate to have surgery
50
Q

why need small to moderate size prostate for brachytherapy

A

seeds should be placed close together

51
Q

side effect of brachytherapy

con of brachytherapy

A
  • can cause swelling of prostate -> can cause problems voiding
    hence need normal urine flow to begin with
52
Q

con of brachytherapy

A

hard to know whether it can cure prostate cancer or not

53
Q

complications of radiotherapy

A
  • fatigue
  • urinary frequency
  • urinary strictures
  • erectile dysfunction
  • changes to bowels
  • radiation burns (external beam radiotherapy)
54
Q

treatments for Advanced and Metastatic Disease (2)

A
  • Androgen Deprivation Therapy
  • Other Systemic Therapy (eg/ cytotoxic chemotherapy, biphosphonates)
55
Q

reason behind Androgen Depravation Therapy

A
  • testosterone = major growth factor for prostate cancer
  • androgen depravation therapy aims to restrict access to testosterone hence restrict growth of cancer
56
Q

side effects of Androgen Depravation Therapy

A

menopause like symptoms

57
Q

medication for Androgen Depravation Therapy

A

GnRH agonists (stimulate release GnRH) of GnRH antagonists (block GnRH -> prevent production FSH, LH hence testosterone)

58
Q

how are GnRH agonists useful for androgen depravation therapy

A
  • stimulate release of GnRH-> initially cause increase in production and release of gonadotrophins (initial surge)
  • overtime they lead to downregulation and desensitisation of GnRH receptors -> decrease in gonadotrophin release

increase testosterone briefly; continuous administration ends up inhibiting FSH, LH -> suppress testosterone production

59
Q

benefits of androgen depravation therapy

A
  • reduce tumour growth
  • symptomatic benefit
60
Q

who helps decide use of Other Systemic Therapy for treatment of advanced and metastatic disease

A

multidisciplinary team

61
Q

2 groups recommending prostate cancer screening

A
  • RACGP
  • prostate cancer foundation of australia
62
Q

old biopsy method for prostate screening diagnostics had issues because

A
  • risk of infection due to site where biopsy was taken
63
Q

prostate cancer screening has been not recommended since harms of screening outweighed benefits from factors such as

A
  • emotional distress from false positive screening tests or false positive biopsies
  • complications with biopsy (infection)
  • harms (side effects) related to overtreatment (many prostate cancers won’t go on to cause problems)
64
Q

do RACGP recommend prostate cancer screening

A

no

65
Q

what do RACGP suggest

A
  • discussion between patient and their GP regarding risks and benefits of screening
  • if patient still wants screening after discussion, PSA is recommended every 2 years
66
Q

why are DREs not recommended for prostate cancer screening (by both organisations)

A
  • sensitivity not very high
  • DRE can elevate some body’s PSA -> false positive result
  • distressing for patient
67
Q

unlike RACGP, prostate cancer foundation of Australia think that prostate cancer screening

A

should be more widespread

68
Q

prostate cancer foundation of australia want screening to be _____ by everybody; only………

A
  • discussed
  • only for those who are interested in prostate screening after
69
Q

age range for screening by prostate cancer foundation of australia is from

A
  • risk stratification based on family history
70
Q

from prostate cancer foundation of australia, screening is not recommended after age ? since

A

70yo
- risks outweigh benefits

71
Q

why is screening becoming less frowned upon

A

as new technologies come in such as prostate MRI, new biopsy (trans-perineal instead of trans-rectal)

72
Q

what bodily locations doe prostate cancer usually spread to (2)

A
  • bones
  • lymph nodes
73
Q

prostate zones on MRI

A
  • transition zone (anterior): benign prostatic hypertrophy
  • peripheral zone (posterior): most cancers
74
Q

prostate zones across ages

A
  • young: small transition zone, much larger peripheral zone
  • adult: larger transition zone ie/ benign prostatic hypertrophy, peripheral zone gets smaller
  • elderly: very large transition zone, peripheral zone can be so small
75
Q

benign prostatic hypertrophy

A
  • non-cancerous enlargement of prostate gland
  • organised chaos
  • can push prostate into other structures (eg/ bladder)
  • urethra gets squished in transition zone - hence issues voiding
76
Q

with age often get ____ in peripheral zone which leads to irregular looking areas

this means what for cancers here

A
  • scarring
  • difficult to find tumour
77
Q

in prostate cancer a lot of extension is _____ so sensitivity of MRI is low for staging prostate cancer

A
  • microscopic
78
Q

MRI for prostate cancer detection (pT2)

A

useful

79
Q

MRI for prostate cancer staging (pT3)

A

not useful

80
Q

cancer is ____ of cells packed ____ together, and so ___ diffusion is helpful in detecting

A
  • lots
  • restricted
81
Q

do any cancers occur in transition zone

what helped be able to find these

A

yes

PI-RADS

82
Q

PSMA PET scan stands for

A

prostate specific membrane antigen

83
Q

radioactive tracer gets _____ into patient and it is linked to ____

A
  • injected
  • PMSA
84
Q

radioactive tracer ____ in parts of the body that takes out the ____ & patients emits _____ which is detected by the scanner

A
  • collects
  • PSMA
  • radiation
85
Q

PSMA is not that _____ so can have false ____ on PSMA PET

A
  • specific
  • positives
86
Q

do all prostate cancers pick up PSMA, are these likely to be higher or lower grade cancers

A

no

high

87
Q

PSMA PET has made a signif difference in being able to detect ____
that may not be picked up on routine __

A

nodes

CT

88
Q

what else can PSMA PET be used for

A

primary staging
localisation of recurrence
treatment planning
assessment of treatment response
restaging

89
Q

prostate cancer imaging now

A
  • multi parametric MRI - for cancer detection
  • MRI - staging (aware can’t be microscopic T3)
  • PI-RADS v2.1 - cancer detection and staging
  • PSMA PET - identifying nodes and mets
  • CT abdo as backup

Adult Health Issues + Men's Health (4 decks)

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