Prostate Cancer Flashcards
Describe anatomy of prostate
Located at the base of bladder
Urethra flows through prostate = lower urinary tract symptoms
Secretes semen
Which race has the highest incidence rate?
African/Caribbean origin
What are the risk factors?
Male sex
>50
Family history
African-American/Caribbean race-risk elevated
Smoking
Testosterone exposure
Weight
Infections with STDs
Increased frequency of ejaculation
What are the normal PSA levels?
<3.0ng/ml - males 50-59
<4.0 60-69
<5.0 70-79
>10 = 50% increase in likelihood of cancer
Why may PSA levels be unreliable?
Can be high from…
Riding a bike
UTI
Increased sexual activity
Certain medications
What is the presentation?
LUTS
= increased frequency of urination
Nocturia
Urgency, hesitancy + reduced flow
Incomplete bladder emptying
Infection
Elevated PSA
Blood in ejaculate
BUT these symptoms are common as men age anyway
What are the investigations?
Transrectal ultrasound
Biopsy
Digital rectal examination - BUT can’t feel whole prostate
What is the staging?
T1 = small tumour - too small to be detected in rectal exam - no symptoms (localised)
T2 = tumour large enough to be detected with rectal exam (localised)
T3 + T4 = cancer spread to surround tissues (advanced)
N1 = cancer spread to lymph nodes (metastatic)
M1a = cancer spread to lymph nodes NOT near prostate
M1b = cancer spread to bones
How is the Gleason score assessed?
From 3-5
With 2 most common scored cell types added together
What is a Gleason score of 6(3+3)?
Grade group 1
Cancer likely to grow very slow
Cells look similar to normal cells
What is a Gleason score of 7(3+4)?
Grade group 2
Most cells look similar to normal
Cancer grow slowly
What is a Gleason score of 7(4+3)?
Grade group 3
Cells look less normal
Cancer grows moderate rate
What is a Gleason score of 8(4+4)?
Grade group 4
Some cells look abnormal
Cancer might grow quickly or moderately
What is a Gleason score of 9(4+5/5+4) or 10(5+5)?
Grade group 5
Cells look very abnormal
Cancer grows quickly
What is the low risk (Cambridge prognostic group 1)?
Gleason score 6 = grade group 1
PSA <10
T1/2
What is the intermediate risk (Cambridge prognostic group 2)?
Gleason score 3+4 = grade group 2
PSA 10-20
T1/2
What is the intermediate risk (Cambridge prognostic group 3)?
Gleason score 4+3 = grade group 3
T1/2
What is the high risk (Cambridge prognostic group 4)?
Gleason score 8 = grade group 4
PSA >20
T3
What is the high risk (Cambridge prognostic group 5)?
Gleason score 9-10 = grade group 5
OR T4
What are the adverse effects of radical (surgery) therapy?
Incontinence
Loss of sexual function
Impotence
Bowel problems
May need medicines to manage SEs
What does NICE recommend for localised prostate cancer?
Luteinising hormone-releasing agonists
Goserelin = Zoladex
Pellet delivered S/C
4 weekly/12 weekly implants
What is the MoA of Zoladex?
Bind to LHRH receptors = initial increase in LH + FSH = boosts testosterone
Continuous stimulation = desensitisation + suppression of receptors
= decrease in testosterone
Why can an initial surge in testosterone be a problem with Zoladex?
Large tumours = grow = urinary obstruction, bone pain + nerve compression
= preceded 3 days by anti-androgen (cyproterone) + continued 3 weeks after LHRHa
What are the adverse effects of LHRHa?
Reduction in testosterone =
Impotence
Loss of libido
Hot flushes
Mood changes
Hair loss
Weight gain
Muscle loss
Psychological for the patient = loss of self-esteem
How is Degarelix different?
Doesn’t cause tumour flare
= immediately block gonadotropin releasing hormone = directly supresses LH + FSH release = testosterone decrease
How does anti-androgens work?
eg. Cyproterone + Bicalutamide
Competitively inhibits androgen receptor on prostate = inhibits testosterone release by testes + adrenal gland
What is Enzalutamide + Abiraterone licensed for?
Men who have stopped responding to hormone therapy BUT haven’t had chemo
What is the MoA of Enzalutamide?
Blocks androgen receptor = stops activation = stops growth signalling = cancer cells stop growing + die
What is the MoA of Abiraterone?
Blocks CYP17A1 (active in prostate, testes + adrenal gland)
Stops testosterone production in all sources = decreases testosterone to undetectable levels
= inhibits cancer progression
Given with prednisone to prevent adrenal insufficiency
