Prostate cancer Flashcards
How many anatomical lobes does the prostate have?
5
How many pathological zones does the prostate have?
4
Which zone are most prostate cancers in?
peripheral zone
Which lobe can be palpated during a DRE?
posterior
Prostate cancer risk factors
increasing age
family history
ethnicity (afro-caribbean men)
germline mutations (BRCA1 and BRCA2)
diet (high in saturated fat)
What is the main pathological type of prostate cancer?
adenocarcinoma
Which local structures can prostate cancer spread to?
seminal vesicles
bladder
rectum
Which lymph nodes does prostate cancer spread to?
pelvic
para-aortic
Which distant organs does prostate cancer spread to?
bone
liver
lung
Prostate cancer clinical presentation
asymptomatic (incidental raised PSA)
LUTS (frequency, urgency, dysuria, nocturia, poor stream, hesitancy)
haematuria
perineal pain
bone pain
Prostate cancer investigation
PSA (2 raised at least)
DRE
pre-biopsy multiparametric MRI
Biopsy
CT if PSA>40
radionuclide bone scan
What is Gleason scoring in prostate cancer?
based on microscopic appearance of biopsy specimen
measure of aggressiveness of tumour
What score is used to grade prostate cancer and predict prognosis?
Gleason score
T staging for prostate cancer (part of TNM)
T = no palpable or visible tumour on imaging
T2 = palpable tumour confined to prostate
T3 = tumour extends through prostatic capsule
T4 = tumour invades adjacent structures
What radical treatments are available for prostate cancer?
surgery
external beam radiotherapy
interstitial brachytherapy
Risks of radical prostate resection?
erectile dysfunction
urinary disturbance
urinary incontinence
Risks of external beam radiotherapy/interstitial brachytherapy for prostate cancer?
erectile dysfunction
urinary disturbance
bowel disturbance
late secondary cancers
Prostate cancer treatment for locally advanced and metastatic disease?
locally advanced = radical or palliative treatment (radiotherapy, hormone therapy)
metastatic = palliative (hormone, radiotherapy to specific sites, androgen receptor therapy, chemotherapy, bisphosphonates, best supportive care)
What drugs can be used for hormone therapy in prostate cancer?
(‘androgen deprivation therapy’)
gonadotrophin-releasing hormone analogues (LHRH analogues) = goserelin
androgen receptor antagonists = bicalutamide
androgen synthesis inhibitors (CYP17) = abiraterone
oestrogens = diethylstilboestrol
orchidectomy
Side effects of hormone therapy for prostate cancer
hot flushes
reduced libido
erectile dysfunction
gynaecomastia
osteopaenia
sarcopaenia
insulin resistance
weight gain
mood swings
fatigue
Spinal cord compression signs
tender to palpation
reduced power in legs
reduced sensation
reduced anal tone
urinary retention
Spinal cord compression immediate management
high dose steroid until definitive treatment - dexamethasone 16mg per day, PPI for gastroprotection
urgent MRI whole spine - can have multiple areas of compression, symptoms do not predict level of compression
Spinal cord compression continuing management
decompression surgery
radiotherapy
interventional radiology (vertebroplasty/kyphoplasty)
supportive care
