Prostate cancer Flashcards
Who is Prostate cancer more common in?
Old, afrocarribean
pathophysiology of Prostate cancer?
adenocarcinoma
peripheral zone of the prostate
Presentation of Prostate cancer?
usually asymptomatic
LUTS
systemic: wt loss/fatigue
Mets: Bone pain
what would you find on examination for Prostate cancer?
Hard irregular prostate on PR with loss of midline sulcus
Where does Prostate cancer spreasd?
Local: seminal vesicles, bladder, rectu
lymph: paraaortic
Haem: bony lesions
Ix in Prostate cancer?
Bloods: PSA. U+E, alk phos. ca
CXR and Spine
TRUS and biopsy
bone scan
staging mr
What is PSA and what doess it tell you?
Proteolytic enzyme used in liquefication of ejaculate
Not specific for Ca, increases with age, PR, TURP and prostatitis
only 1 in 3 will have Ca at >4ng/ml
normal in 30% small cancers
Gleason score is what?
scoring of the two worst affected areas, sum is inversely proportional to the prognosis
TNM?
1=incidental
2=intracapsular
3=extra prostatatic extension
4=pelvis/surrounding structures
Prognostic factors in Prostate cancer?
Age, PSA, tumour stage and grade
Conservative management of Prostate cancer?
Active monitoring: close monitoring with DRE and PSA
Radical therapy in Prostate cancer?
Radical prostatectomy and goserelin if node positive laprascopically with robot only improves survival if <75 Brachytherapy: palladium seeds s/e= ED, incontinence, death
Medical therapy in Prostate cancer?
used for metastatic or node positive disease
LNRH analogues: goserelin- inhibits gonadotrophins and decreases testosteron
coprescribe with antiandrogens as flare: cyproterone acetate, flutamide
Symptomatic management in Prostate cancer?
TURP for obstruction
analgesia
radiotherapy for bone mets
