Prostate cancer Flashcards
What is the most common cancer in UK males over 50?
Prostate cancer
What are some risk factors for prostate cancer?
- Ageing
- Genetics
- Cadmium batteries
Is BPH a form of pre-malignant prostate cancer?
NO
What are the 3 histological sub-types of prostate cancer?
- Prostatic acinar adenocarcinoma (Most common)
- Prostatic ductal carcinoma
- Small cell carcinoma
What are the 3 main zones of the prostate?
Central zone - Surrounding ejaculatory duct
Peripheral zone - Potserolateral, malignant cancers arise here
Transitional zone - Surrounds prostatic urethral, BPH arises here
Which zone of the prostate does prostate cancer occur in?
Peripheral zone
How will prostate cancer present?
Asymptomatic
Haematospermia
Haematuria
Obstruction - Hesitancy, reduced flow
Bone pain (Metastasis)
Weight loss, anorexia, fever
What tests are required in suspected prostate cancer?
PSA
Bloods
PR exam
Trans-rectal US-guided biopsy
MRI and bone scan
What is PSA
Prostate Specific Antigen - Glucoprotein enzyme kallikrein 3
What is the function of kallikrein 3 (PSA) normally
Liquifies semen in ejeculate and allows sperm to swim
What are some things that can cause a raised PSA?
Prostate cancer
BPH
Prostatitis
Ejaculation
Cycling
Sit-down jobs
What are some negatives of PSA testing?
Not produced by high grade cancers
15% of negative tests will have cancer
Borderline raised PSAs have a 25% chance of having cancer
Only 50% of cases of raised PSA will have cancer
What should be avoided before PSA testing?
Vigorous exercise, cycling and ejaculation for 48 hours before exam
Rectal exam should be done after PSA test
What are some prostate characteristics on PR that suggest prostate cancer?
Enlarged
Hard
Irregular
Asymmetrical
What score is used to determine prognosis of prostate cancer?
Gleason score
How is the Gleason score calculated?
The two most common morphologies of the prostate tumour are determined, then their scores are added together giving a score /10 which determines prognosis
Clinically, only scores 3, 4 and 5 are used
What will be seen on bone scan in prostate cancer?
Osteosclerosis
How are low grade, localised and slow growing prostate cancers managed?
Follow up examinations to monitor and ensure no progression
How is medium/high risk, localised prostate cancer managed?
Prostatectomy
Radiotherapy
How is prostatectomy carried out?
Robotically - Most common robotic surgery in the world
What are some side effects to prostatectomy?
Most men will have some form of sexual dysfunction following prostatectomy and stress incontinence (Managed by physiotherapy and can go away)
What are the 2 forms of radiotherapy used in prostate cancer management?
External beam radiotherapy
Brachytherapy
Who is prostatectomy given to in prostate cancer?
Younger patients, so that radiotherapy can be used in cases of relapse (Both procedures are equally effective)
What is involved in brachytherapy?
Radioactive implantation around the prostate to target the cancer
How is advanced or metastatic prostate cancer managed?
LHRH agonists (Leutenising hormone releasing hormone)
Anti-androgens
How do LHRH agonists and anti-androgens help in prostate cancer?
Inhibits testosterone which slows the progression of prostate cancer (Induces a form of male menopause)
