Prostate Cancer Flashcards
1
Q
What is the anatomical location of the prostate gland?
A
The prostate gland surrounds the proximal urethra.
2
Q
What factor is prostate growth dependent on?
A
Prostate growth is dependent on testosterone.
3
Q
What percentage of semen volume is contributed by the prostate gland?
A
The prostate gland contributes about 20% of semen volume.
4
Q
What does the prostate gland secrete?
A
The prostate gland secretes Prostate-specific Antigen (PSA).
5
Q
What is a common pathology of the prostate gland involving non-cancerous enlargement?
A
Benign Prostatic Hyperplasia (BPH) is a common pathology involving non-cancerous enlargement of the prostate.
6
Q
What is prostatitis?
A
Prostatitis is inflammation of the prostate gland, often caused by infection.
7
Q
What is a major malignant condition of the prostate gland?
A
Prostate cancer is a major malignant condition of the prostate gland
8
Q
What is the global ranking of prostate cancer in terms of malignancy?
A
Prostate cancer is the 2nd most common malignancy worldwide.
9
Q
What is the disease spectrum of prostate cancer?
A
The disease spectrum ranges from clinically insignificant to highly aggressive forms of prostate cancer.
10
Q
What percentage of men with prostate cancer die from the disease?
A
Only 3% of men with prostate cancer die from the disease.
11
Q
How does age influence the risk of developing prostate cancer?
A
The risk of prostate cancer increases with age.
12
Q
Which racial/ethnic group has an increased risk of prostate cancer?
A
African-American men have an increased risk of prostate cancer.
13
Q
How does family history influence the risk of prostate cancer?
A
A family history of prostate cancer increases the risk of developing the disease.
14
Q
Which genetic mutations are associated with an increased risk of prostate cancer?
A
BRCA mutations and Lynch syndrome are associated with an increased risk of prostate cancer.
15
Q
What is the most common histological type of prostate cancer?
A
Most prostate cancer is adenocarcinoma.
16
Q
Where does prostate cancer typically originate?
A
Prostate cancer usually originates from the peripheral zone of the prostate.
17
Q
How does prostate cancer typically spread?
A
Prostate cancer spreads by local invasion through the prostate capsule, hematogenous spread, and lymphatic spread.
18
Q
How was prostate cancer traditionally graded?
A
Prostate cancer was traditionally graded using the Gleason grading system (6-10), based on the architectural pattern of prostate cancer glands, which were scored from 1 to 5, with the two most common patterns combined to give a grade out of 10.
19
Q
What grading system is now used for prostate cancer?
A
The ISUP (International Society of Urological Pathology) Prostate Cancer Grade Groups (1-5) are now used.
20
Q
What are the most common sites for prostate cancer metastasis?
A
The most common sites of metastasis are bone and pelvic lymph nodes, with less frequent metastasis to the liver and lungs.
21
Q
What is the most common presentation of prostate cancer in its early stages?
A
The majority of prostate cancer cases are asymptomatic in the early stages
22
Q
What laboratory finding is commonly associated with prostate cancer?
A
Elevated Prostate-specific Antigen (PSA) is commonly associated with prostate cancer.
23
Q
What is a typical finding on digital rectal examination (DRE) in prostate cancer?
A
A hard nodule may be felt on digital rectal examination (DRE).
24
Q
What symptom may indicate locally advanced prostate cancer?
A
Hematuria (blood in the urine) can occur in locally advanced prostate cancer.
25
What urinary symptoms may be seen in locally advanced prostate cancer?
Lower urinary tract symptoms (similar to BPH) such as difficulty urinating, frequency, and urgency may occur in locally advanced prostate cancer.
26
What other symptoms can indicate locally advanced prostate cancer?
Constipation and perineal pain may also be present in locally advanced prostate cancer.
27
What is a common symptom of advanced metastatic prostate cancer?
Bone pain is a common symptom in advanced metastatic prostate cancer.
28
What other clinical signs can be seen in advanced metastatic prostate cancer?
Anemia and renal failure can also be seen in advanced metastatic prostate cancer.
29
What are the benign causes for an elevated PSA
- BPH
- Acute prostatitis
- Subclinical inflammation
- Prostate biopsy
- Cystoscopy
- TURP
- Urinary retention
- Ejaculation
- DRE
- Perineal trauma
- Prostatic infarction
30
Should prostate cancer screening be done in men with a life expectancy of less than 10 years?
No, prostate cancer screening should not be done in men with a life expectancy of less than 10 years.
31
Should men aged 55 to 69 with normal risk be screened for prostate cancer?
Yes, men with normal risk between the ages of 55 and 69 can be offered screening if they are appropriately counseled about the risks of over-diagnosis and over-treatment.
32
When should early screening for prostate cancer be considered?
Early screening should be considered if there is a family history of prostate cancer.
33
What are the common methods used for screening prostate cancer?
Prostate cancer screening is done using Serum PSA (Prostate-Specific Antigen) and Digital Rectal Examination (DRE).
34
What is the sensitivity and specificity of Serum PSA in prostate cancer screening?
Serum PSA has high sensitivity but low specificity for prostate cancer.
35
What other conditions can cause elevated PSA levels besides prostate cancer?
Other causes of elevated PSA include benign prostatic hyperplasia (BPH), prostatitis, and recent urinary tract procedures.
36
Why is age-adjusted PSA used in prostate cancer screening?
Age-adjusted PSA helps account for normal increases in PSA levels with age, providing more accurate screening results.
37
What are the common methods for performing a prostatic biopsy?
Prostatic biopsy can be done using transrectal or transperineal approaches, both guided by ultrasound, or using MRI fusion for more precision.
38
When should a prostate biopsy be considered?
A prostate biopsy should be considered if there is an elevated PSA, a hard nodule or hard/nodular prostate on digital rectal examination (DRE), or if PSA > 4 ng/ml.
39
When should prostate biopsy not be performed?
Prostate biopsy should not be performed during urinary retention or urinary tract infection (UTI).
40
Prostate biopsy should not be performed during urinary retention or urinary tract infection (UTI).
No, there is no absolute PSA value considered "normal." Any elevated PSA may require further investigation, including biopsy.
41
What is the purpose of staging in prostate cancer?
Staging helps in selecting the appropriate treatment for prostate cancer
42
Which factors are used to risk stratify prostate cancer?
PSA levels, clinical staging based on digital rectal examination (DRE), and Gleason/ISUP grading are used to risk stratify prostate cancer.
43
Do low-risk prostate cancer patients usually require additional staging imaging?
No, low-risk prostate cancer patients typically do not require additional staging imaging.
44
What tools can be used for prostate cancer risk stratification?
Tools such as the European Association of Urology (EAU), National Comprehensive Cancer Network (NCCN) guidelines, and online nomograms are used to predict risks such as biochemical failure, positive margins, and positive nodes.
45
Why is risk stratification important in prostate cancer?
Risk stratification is valuable in decision-making and patient counseling, as it helps predict the likelihood of treatment outcomes and complications.
46
What is the TNM staging system for prostate cancer?
The TNM staging system classifies prostate cancer based on three criteria:
- T (Tumor): Describes the size and extent of the primary tumor.
- N (Nodes): Describes the extent of regional lymph node involvement.
- M (Metastasis): Describes the presence or absence of distant metastasis.
47
What does the "T" stage represent in prostate cancer?
The "T" stage represents the extent of the primary tumor and how far it has spread within the prostate or beyond.
48
What does a T1 staging indicate in prostate cancer?
T1 indicates that the tumor is confined to the prostate and is clinically undetectable.
- T1a: Tumor discovered incidentally during surgery for another condition, involving <5% of tissue.
- T1b: Tumor discovered incidentally, involving >5% of tissue.
- T1c: Tumor identified through needle biopsy due to elevated PSA levels
49
What does a T2 staging indicate in prostate cancer?
T2 indicates that the tumor is confined to the prostate but is palpable or visible on imaging.
- T2a: Tumor involves one-half or less of one lobe of the prostate.
- T2b: Tumor involves more than one-half of one lobe but does not extend to the other side.
- T2c: Tumor involves both lobes of the prostate
50
What does a T3 staging indicate in prostate cancer?
T3 indicates that the tumor has extended beyond the prostate capsule but has not invaded nearby organs.
- T3a: Tumor extends through the prostate capsule but does not involve nearby structures.
- T3b: Tumor has invaded the seminal vesicles.
51
What does a T4 staging indicate in prostate cancer?
T4 indicates that the tumor has invaded nearby structures, such as the bladder, rectum, or pelvic wall.
52
What does the "N" stage represent in prostate cancer?
The "N" stage indicates the extent of regional lymph node involvement, assessing whether cancer has spread to nearby lymph nodes.
53
What does N0 mean in the lymph node staging of prostate cancer?
N0 means there is no evidence of regional lymph node involvement.
54
What does N1 mean in the lymph node staging of prostate cancer?
N1 means there is evidence of regional lymph node involvement, indicating the cancer has spread to nearby lymph nodes.
55
What does the "M" stage represent in prostate cancer?
The "M" stage indicates whether the cancer has spread to distant organs or other parts of the body, such as bones, lungs, or liver.
56
What does M0 mean in prostate cancer staging?
M0 means there is no evidence of distant metastasis.
57
What does M1 mean in prostate cancer staging?
M1 means the cancer has spread to distant organs.
- M1a: Spread to distant lymph nodes.
- M1b: Spread to bones.
- M1c: Spread to other distant organs such as the liver or lungs
58
How is prostate cancer staged using the TNM system?
The TNM staging system for prostate cancer includes:
T: Tumor extent (T1-T4)
N: Lymph node involvement (N0-N1)
M: Distant metastasis (M0-M1)
59
How is TNM staging used in clinical practice for prostate cancer?
TNM staging helps in determining prognosis, selecting appropriate treatment (such as surgery, radiation, or hormone therapy), and predicting the risk of recurrence and metastasis. The stage also guides patient counseling and management decisions.
60
What factors determine the treatment approach for prostate cancer?
Treatment depends on the stage of the disease and the patient's life expectancy.
61
What treatment options are available for localized prostate cancer?
Expectant management: Monitoring the disease closely without active treatment, often used for low-risk patients.
Radical (curative) treatment: Options include surgery (radical prostatectomy) or radiation therapy, depending on the individual case.
62
What treatment options are available for metastatic or locally advanced prostate cancer?
The main approach includes hormonal manipulation to reduce testosterone levels, which fuel the cancer growth.
63
What is the role of hormonal manipulation in metastatic or locally advanced prostate cancer?
Hormonal manipulation, such as androgen deprivation therapy (ADT), aims to reduce or block testosterone production, slowing down or shrinking the cancer.
64
What treatment is used for castrate-resistant metastatic prostate cancer?
Docetaxel chemotherapy: A chemotherapy option used to treat castrate-resistant prostate cancer.
New hormonal drugs: These include abiraterone, enzalutamide, and others that block androgen signaling or androgen production.
Radium-223: Used for patients with bone metastases to reduce bone pain and improve survival.
Sipuleucel-T: A form of immunotherapy that stimulates the immune system to target prostate cancer cells.
65
What are the treatment approaches for localized or organ-confined prostate cancer?
Expectant management: Includes active surveillance for low-risk cases or watchful waiting for those with a limited life expectancy.
Radical (curative) treatment: Surgery (radical prostatectomy) or radiation therapy, depending on the patient's health and the disease's characteristics.
66
What is active surveillance and when is it used in localized prostate cancer?
Active surveillance involves regular monitoring of the cancer with PSA tests, biopsies, and imaging. It is typically used for low-risk, slow-growing prostate cancer. If progression is detected, radical treatment (e.g., surgery or radiation) may be initiated.
67
What is the difference between active surveillance and watchful waiting?
Watchful waiting is for older or frail patients with limited life expectancy, where the goal is palliation and not curative treatment. Treatment, such as hormonal manipulation, is given if the cancer progresses.
Active surveillance involves more frequent monitoring and is used in patients with good life expectancy and low-risk disease.
68
What is radical prostatectomy and when is it used?
Radical prostatectomy is a surgical procedure to remove the prostate and surrounding tissue. It is used for patients with localized or organ-confined prostate cancer who are young, healthy, and fit for surgery.
69
What are the different approaches for performing a radical prostatectomy?
Radical prostatectomy can be performed using:
- Open surgery: Traditional method involving a large incision.
- Robotic-assisted surgery: Minimally invasive, using robotic arms for precision.
- Laparoscopic surgery: A minimally invasive approach using small incisions and a camera.
70
What are the types of radiation therapy used for localized prostate cancer?
External beam radiation: High-energy radiation is directed at the prostate from outside the body.
Low dose rate brachytherapy: Involves placing radioactive seeds directly into the prostate to deliver radiation locally.
71
What is multimodal treatment, and when is it used in prostate cancer?
Multimodal treatment involves combining different therapies, such as surgery and radiation, for patients with locally advanced or high-risk prostate cancer. This approach aims to improve outcomes by targeting the cancer from multiple angles.
72
Why might young, healthy, and fit patients with localized prostate cancer delay definitive treatment?
These patients may delay definitive treatment (such as radical surgery or radiation) to avoid the side effects of treatment and allow for monitoring of the cancer's progression, choosing active surveillance instead.
73
How is locally advanced or high-risk prostate cancer treated?
For locally advanced or high-risk prostate cancer, a more aggressive treatment approach is used, often combining surgery with radiation therapy. Hormonal therapy may also be employed to shrink the tumor before radiation.
74
What is the role of hormonal manipulation in metastatic or advanced prostate cancer?
Hormonal manipulation is used to reduce the levels of testosterone, which prostate cancer cells depend on for growth. The aim is to shrink metastases and the prostate gland, provide symptom palliation, but it does not increase survival.
75
How does hormonal manipulation work in treating metastatic prostate cancer?
Hormonal manipulation works by lowering testosterone levels, which are necessary for prostate cancer cell growth. This can shrink metastases and alleviate symptoms, but it does not cure the disease or extend survival in the long term.
76
What is bilateral orchidectomy, and how does it help in managing metastatic prostate cancer?
Bilateral orchidectomy is a surgical procedure to remove both testes, drastically reducing testosterone production. It is a definitive form of hormonal manipulation for metastatic prostate cancer.
77
What are the medical options for hormonal manipulation in metastatic prostate cancer?
LHRH analogues (e.g., leuprolide, goserelin): These drugs suppress testosterone production by acting on the pituitary gland.
Oestrogens: These hormones can also lower testosterone levels, but are less commonly used due to side effects.
Anti-androgens (e.g., bicalutamide, flutamide): These block the action of testosterone at the prostate cancer cell level.
78
What is the effectiveness of hormonal manipulation in metastatic prostate cancer?
Hormonal manipulation effectively shrinks metastases and the prostate, providing good symptom palliation. However, it does not improve survival and the response to treatment can vary among patients.
79
What is castrate-resistant prostate cancer, and when does it occur?
Castrate-resistant prostate cancer occurs when the cancer no longer responds to hormonal therapy, even after testosterone levels have been reduced to very low (castrate) levels. This typically happens after initial hormone therapy.
80
What are the physical side effects of androgen deprivation therapy (ADT) in metastatic prostate cancer?
Weight gain
Gynecomastia (breast enlargement)
Muscle weakness
Muscle atrophy
81
What are the sexual side effects of androgen deprivation therapy (ADT) in metastatic prostate cancer?
Erectile dysfunction
Decreased libido
Genital shrinkage
82
What are the metabolic side effects of androgen deprivation therapy (ADT) in metastatic prostate cancer?
Osteoporosis
Anemia
Hot flashes
Increased risk of hypertension, diabetes, heart disease, and lipid abnormalities
83
What are the emotional and cognitive side effects of androgen deprivation therapy (ADT) in metastatic prostate cancer?
Depression
Mood instability
84
What are the systemic side effects of androgen deprivation therapy (ADT) in metastatic prostate cancer?
Fatigue
Reduced energy levels
85
Androgen Deprivation therapy drugs
- Abiraterone acetate
- Cabazitaxel
- Denosumab
- Docetaxel
- Enzalutamide
- Radium 223
- Sipuleucel- T
86
What is the role of abiraterone acetate in androgen deprivation therapy for metastatic prostate cancer?
Target: CYP17A1
Effect: Lowers circulating testosterone levels by inhibiting CYP17A1, an enzyme involved in testosterone production.
87
How does cabazitaxel work in androgen deprivation therapy for metastatic prostate cancer?
Target: Microtubules
Effect: Stabilizes microtubules and disrupts the cell cycle, leading to cancer cell death.
88
What is the role of denosumab in androgen deprivation therapy for metastatic prostate cancer?
Target: RANKL
Effect: Reduces bone resorption by inhibiting RANKL, which decreases the risk of bone fractures and skeletal-related events.
89
How does docetaxel contribute to androgen deprivation therapy in metastatic prostate cancer?
Target: Microtubules
Effect: Stabilizes microtubules and disrupts the cell cycle, resulting in cancer cell death and reduced tumor growth.
90
What is the mechanism of action of enzalutamide in androgen deprivation therapy for metastatic prostate cancer?
Target: Androgen receptor (AR)
Effect: Blocks androgen receptor signaling, inhibiting the effects of testosterone on prostate cancer cell growth.
91
How does radium-223 work in androgen deprivation therapy for metastatic prostate cancer?
Target: Bone
Effect: Provides localized radiation to bone metastases, reducing bone pain and improving survival in patients with bone involvement.
92
What is the role of sipuleucel-T in androgen deprivation therapy for metastatic prostate cancer?
Target: Activates PBMCs via GM-CSF and PAP
Effect: Stimulates T-cell activation and enhances the immune response against prostate cancer cells.
93
What is the approach to best supportive care in metastatic castrate-resistant prostate cancer (CRPC)?
Best supportive care focuses on symptom management and improving quality of life. This includes:
- Pain management
- Managing obstructive lower urinary tract symptoms (LUTS)
-Palliative care team referral for holistic support.
94
How is pain managed in metastatic castrate-resistant prostate cancer (CRPC)?
Pain management involves a stepwise escalation of analgesia, starting with:
- Mild pain: Non-opioid analgesics (e.g., acetaminophen or NSAIDs).
- Moderate pain: Weak opioids (e.g., tramadol).
- Severe pain: Strong opioids (e.g., morphine or oxycodone).
For bone metastases, bisphosphonates or denosumab may also be used to reduce skeletal complications.
95
How is radiation used in managing painful bone metastases in metastatic castrate-resistant prostate cancer (CRPC)?
Radiation therapy can be used to manage bone pain, providing localized relief for painful bone metastases. This can be either:
- External beam radiation
-Radium-223 (for bone metastases with symptomatic relief).
96
What are the treatment options for managing obstructive lower urinary tract symptoms (LUTS) in metastatic castrate-resistant prostate cancer (CRPC)?
For obstructive LUTS, channel TURP (transurethral resection of the prostate) can be considered to relieve urinary obstruction.
97
How is intractable hematuria managed in metastatic castrate-resistant prostate cancer (CRPC)?
Radiation to the prostate can be used to manage intractable hematuria by reducing bleeding from prostate tumors.
98
When should a palliative care team be referred in metastatic castrate-resistant prostate cancer (CRPC)?
Referral to the palliative care team should be considered early in metastatic CRPC to help manage symptoms such as pain, fatigue, emotional distress, and provide holistic support for the patient and family.
99
What is castrate-resistant prostate cancer (CRPC)?
CRPC is prostate cancer that continues to progress despite low levels of testosterone, typically following androgen deprivation therapy (ADT).
The cancer is no longer responsive to conventional androgen deprivation, and it progresses even with low serum testosterone levels.
100
What are the mechanisms of resistance in castrate-resistant prostate cancer (CRPC)?
Androgen receptor (AR) mutations: The prostate cancer cells may continue to be stimulated by androgens despite low testosterone.
Increased androgen receptor sensitivity: The cancer cells may become more sensitive to low levels of testosterone.
Increased androgen production: Tumor cells may produce their own androgens, bypassing the need for systemic testosterone.
101
What are the common symptoms of castrate-resistant prostate cancer (CRPC)?
Pain: Particularly in bones due to bone metastases.
Lower urinary tract symptoms (LUTS): Obstructive symptoms may persist.
Fatigue: Due to metastases or the systemic nature of the disease.
Weight loss: As the cancer progresses and leads to cachexia.
Anemia: Due to disease progression or treatment-related effects.
102
How is castrate-resistant prostate cancer (CRPC) diagnosed?
Rising PSA: Despite castration-level testosterone (<50 ng/dL), PSA levels continue to rise.
Clinical progression: Evidence of disease progression (e.g., bone pain, new metastases) while on androgen deprivation therapy.
Imaging: Bone scans, CT, or MRI to identify metastases, particularly in the bone.
103
What are the treatment options for castrate-resistant prostate cancer (CRPC)?
Chemotherapy: Docetaxel and cabazitaxel are used for symptomatic metastatic CRPC.
Androgen receptor signaling inhibitors (ARSI): Enzalutamide and abiraterone acetate are used to block androgen receptor activity.
Radium-223: For bone metastases with symptomatic relief and survival benefits.
Sipuleucel-T: An immune-based therapy for asymptomatic or minimally symptomatic CRPC.
Corticosteroids: Used in combination with other therapies for symptom control.
