Prostate Cancer Flashcards
What percentage of prostate cancers are locally advanced or metastatic at diagnosis?
1/3
Risk factors for prostate cancer (4)
- 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
Typical presentation of prostate cancer
Most are asymptomatic
Sxs of localized disease
Most common sxs result from bladder outlet obstruction: hesitancy, nocturia, incomplete emptying, diminished urine stream.
Sxs of local advanced disease (3)
More significant bladder outlet obstruction, ED, pelvic pain.
Sxs of advanced disease (5)
Bone pain, neuro sxs (due to cord compression from vertebral metastases), weight loss, fatigue, pathologic fractures
In what part of the prostate do most cancers arise?
Peripheral zone
What are normal PSA levels?
0-4 ng/mL. Rise w/ age.
What things other than prostate cancer cause a rise in PSA? (5)
PSA elevated w/ prostatitis, prostate trauma (vigorous bike riding), ejaculation, BPH, and meds.
Screening recommendations
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)
What imaging studies are done for prostate cancer?
Bone scan and CT
From which tissue are most prostate cancers derived from?
What kind of cancer?
Glandular epithelium
Adenocarcinoma
PIN
What is it?
Histology characteristics
Prostatic intraepithelial neoplasia
Characteristics include large nuclei, prominent nucleoli, and still contained.
Histological characteristics of adenocarcinoma (4)
Loss of basal cell layer, small / round / crowded glands, large cells, prominent nucleoli
4 options for treating localized disease
Active surveillance, radical prostatectomy, radiation, androgen deprivation therapy
What does active surveillance involve?
When is it done?
When is definitive treatment suggested?
- 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.
Radical prostatectomy What is removed? Who is the ideal patient? Advantages (6) Complications (2)
- 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.
Radiation Indications Advantages over surgery (4) Acute complications (3) Long-term complications (7)
- 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.
Does surgery or radiation have worse effects on sexual function?
Similar effects
What is the mainstay of treatment for metastatic disease?
Androgen deprivation therapy
4 types of ADT
- Medical castration: LHRH agonists / antagonists
- Surgical castration: bilateral orchiectomy
- Anti-androgens (receptor blockers) - Bicalutamide
- Estrogens (suppress androgen production)
Side effects of ADT (11)
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.
What is the most common side effect of ADT?
What is used to prevent this?
Osteoporosis
Ca / Vit D supplements
Yearly bisphosphonates (Zoledronic acid / Denosumab). Prolongs avg time to SRE from 12 to 17-20 months.
What percentage of pxs get bone metastases?
What kind of tumors are they?
75%
Osteoclastic
