Prostate Cancer Flashcards
What is the most common histology of prostate cancer?
Adenocarcinoma
95 per cent
Mostly in the glandular tissue of the peripheral part of the gland
Possible risk factors for prostate cancer
BRCA2, PTEN, radiation exposure, diet, anabolic steroids
Presentation of prostate cancer
Frequency Hesitancy Poor stream Nocturnal Terminal dribble Haematospermia Erectile dysfunction Bone pain Hyper calcareous Malaise, anorexia, weightless
Investigations in prostate cancer
Transrectal ultrasound guided biopsy
MRI for staging
DRE, PSA useful to indicate need for biopsy
Incidence of prostate cancer
50 percent of men over 75
3rd commonest cancer in men
TNM staging of prostate cancer
T1 - tumour not palpable or imaged T2 - tumour confined within prostate T3 - tumour extends through prostate capsule T4 - tumour is fixed/invades structures N1 - regional node involvement M1 - distant mets
What are the options for localised prostate cancer? T2 or less
Radical prostatectomy
Perineal/retroperitoneal routes
Problems: impotence, 12% mortalit
Possible adjuvant radiotherapy
Radical Radiotherapy
If PSA suggests no mets
Delayed until 6 weeks after turp to prevent structure
Curative if locally confined
Hormonal therapy in prostate cancer
Aims, types, response rate
Used in metastatic disease or to downstage prior to surgery
80% response rate
Lhrh agonist
Gosurelin, leuporelin
Side effects: impotence, loss of libido, tumour flare on initiation
Oestrogen
Rarely used
Side effects: impotence, loss of libido, gynaecomastia, MI
Anti androgen
Bicalutamide, cyproterone
Bilateral orchidectomy
Chemotherapy in prostate cancer. Which drugs, when used.
Docetaxel and prednisolone, cabaxitaxel
In castrate resistant metastatic disease
Prognosis of prostate cancer.
Locally advanced, after radical treatment, if metastatic
Locally advanced: 4.5 years
Locally confined with radical surgery or radio: 80-90% 10 year survival
Metastatic: 2.5 years
