Prostate Cancer Flashcards

1
Q

What percentage of prostate cancers are locally advanced or metastatic at diagnosis?

A

1/3

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2
Q

Risk factors for prostate cancer (4)

A
  • Age: 63% of prostate cancers are diagnosed in men >65 y/o
  • Race: AAs have 1.6x higher rate. More likely to present w/ aggressive disease, and more likely to die. Lowest risk in Asians and those from South America.
  • Obesity associated w/ higher-risk disease. Higher risk w/ saturated fats, red mat, low fruits / veggies, low tomato products (lycopene), and low fish.
  • High fiber diet decreases risk.
  • High DHT
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3
Q

Typical presentation of prostate cancer

A

Most are asymptomatic

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4
Q

Sxs of localized disease

A

Most common sxs result from bladder outlet obstruction: hesitancy, nocturia, incomplete emptying, diminished urine stream.

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5
Q

Sxs of local advanced disease (3)

A

More significant bladder outlet obstruction, ED, pelvic pain.

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6
Q

Sxs of advanced disease (5)

A

Bone pain, neuro sxs (due to cord compression from vertebral metastases), weight loss, fatigue, pathologic fractures

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7
Q

In what part of the prostate do most cancers arise?

A

Peripheral zone

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8
Q

What are normal PSA levels?

A

0-4 ng/mL. Rise w/ age.

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9
Q

What things other than prostate cancer cause a rise in PSA? (5)

A

PSA elevated w/ prostatitis, prostate trauma (vigorous bike riding), ejaculation, BPH, and meds.

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10
Q

Screening recommendations

A

Annual DRE and PSA for men at “average risk” w/ life expectancy >10 years, starting at age 50. Start at age 45 if at high risk (AA or family hx in 2 first-deg relatives)

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11
Q

What imaging studies are done for prostate cancer?

A

Bone scan and CT

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12
Q

From which tissue are most prostate cancers derived from?

What kind of cancer?

A

Glandular epithelium

Adenocarcinoma

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13
Q

PIN
What is it?
Histology characteristics

A

Prostatic intraepithelial neoplasia

Characteristics include large nuclei, prominent nucleoli, and still contained.

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14
Q

Histological characteristics of adenocarcinoma (4)

A

Loss of basal cell layer, small / round / crowded glands, large cells, prominent nucleoli

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15
Q

4 options for treating localized disease

A

Active surveillance, radical prostatectomy, radiation, androgen deprivation therapy

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16
Q

What does active surveillance involve?
When is it done?
When is definitive treatment suggested?

A
  • Semiannual PSA / DRE. Yearly prostate biopsy.
  • Used in pxs w/ very low risk (T1c, Gleason under 6, PSA under 10, less than 20 years of life expectancy; OR low risk (T1c-T2a) w/ less than 10 years life expectancy.
  • Recommend definitive treatment if any Gleason 4/5, >2 cores involved, or >50% involvement of single core.
17
Q
Radical prostatectomy
What is removed?
Who is the ideal patient?
Advantages (6)
Complications (2)
A
  • Remove entire prostate, capsule, seminal vesicles, ampulla, vas, and fascia b/w seminal vesicles / bladder.
  • Ideal px has T1c-T3a N0, life expectancy >10 years, few co-morbidities
  • Younger pxs are more likely to choose surgery due to lower recurrence rates.
  • Pros: cures 2/3 of cases (only?), less time than radiation, pathologic staging, minimal rectal toxicity, radiation still an option if relapse occurs, no secondary malignancies.
  • Complications: urinary distress / incontinence (higher risk than radiation), ED.
18
Q
Radiation
Indications
Advantages over surgery (4)
Acute complications (3)
Long-term complications (7)
A
  • Indications: cure for localized disease, after surgery if positive margins, painful / morbid metastases.
  • Advantages over surgery: cures 2/3 cases, no surgical complications, treat pelvic LN’s, less urinary incontinence than surgery
  • Acute complications: diarrhea, rectal pain / bleeding, dysuria, freq, nocturia
  • Long-term complications: impotence and incontinence are most common. Others include proctitis, rectal ulcers, chronic cystitis, urinary stricture, secondary malignancy.
19
Q

Does surgery or radiation have worse effects on sexual function?

A

Similar effects

20
Q

What is the mainstay of treatment for metastatic disease?

A

Androgen deprivation therapy

21
Q

4 types of ADT

A
  • Medical castration: LHRH agonists / antagonists
  • Surgical castration: bilateral orchiectomy
  • Anti-androgens (receptor blockers) - Bicalutamide
  • Estrogens (suppress androgen production)
22
Q

Side effects of ADT (11)

A

Hot flashes, weight gain, fatigue, loss of muscle strength (low T), low libido, ED (99% of men), emotional lability, osteoporosis, high cholesterol, high BP, high glucose.

23
Q

What is the most common side effect of ADT?

What is used to prevent this?

A

Osteoporosis
Ca / Vit D supplements
Yearly bisphosphonates (Zoledronic acid / Denosumab). Prolongs avg time to SRE from 12 to 17-20 months.

24
Q

What percentage of pxs get bone metastases?

What kind of tumors are they?

A

75%

Osteoclastic