Prostate cancer Flashcards
Outline the risk factors for prostate cancer
Age is the strongest risk factor - mainly affects men who are over 50.
Race - higher incidence if black
Genetic - 2/3 fold increase in risk if 1st degree relative is affected.
Diet high in fat and red meat
Overweight
Where is the prostate located?
Lies below the bladder neck, anterior to rectum, traversed by urehtra
Why is the treatment of prostate cancer difficult?
Lies near many importat structures
Where does prostate cancer commonly metastasise to?
Bones
How are prostate tumors graded?
Either TNM system of Gleason system
What is the Gleason grading system?
Scoring based on what the tumor looks like under a microscope - how well differentiated it is. The more differentiated the better the prognosis.
A score of 2-4 is good, 5-7 moderate and 8-10 poor.
Outline the clinical presentation of prostate cancer
Lower urinary tract symptoms - hesitancy, post-micturition dribbling, decreased void pressure, frequency, urgency, and nocturia.
If locally invasive - perineal pain, impotence incontinence, haematospermia.
How can prostate cancer be diagnosed?
Digital rectal examination (PR) - cannot detect T1 at this stage.
PSA levels in the body
Transurethral ultrasound (TRUS)
CT/MRI scan to detect bone metastases.
What is PSA?
Prostate specific antigen - glyccoprotein secreted by prostatic cells to aid liquidfication of semen.
What are the normal levels of PSA?
0-4ng/ml
Why are PSA levels often increased in prostate cancer?
PSA leaks through cancer cell membrane and into circulation.
Is PSA a good diagnostic test? what else could it be used for?
OK - however up to 20% of men with prostate cancer will not have raised levels and can also be raised for other regions e.g. age, BPH.
PSA can also be used to monitor patients response to treatments.
What kind of surgery is used to treat prostate cancer? When would surgery be appropriate?
Radical prostaectomy - involves removal of the prostate, seminal vesicles and sometimes pelvic lymph nodes.
Only perfomed in patients with stage 1 or 2 dises and who have at least a 10 year life expectancy.
What are the complications associated with radical prostatectomy?
Can result in significant moribidity - impotence in (30-70%), incontinence
When is radiotherapy used to treat prostate cancer?
Carried out in patients who are not suitable for surgery but have good life expectancy and localised disease.
Also used for symptom control in advanced disease and bony metastases
What is brachytherapy?
Delivers radioaction through implantation of needles containing radioactive pellets into prostate glands.
Used in combination with androgen deprivation therpay.
When do we use hormonal therapies?
Used in locally advance and metastatic cancer
What is the idea behind hormone therapies?
Hormonal therapies block androgen drive that sustains most prostate cancers.
What is Goserelin? How does it work and how is it given?
LHRH analog - luteinising hormone-releasing hormone (leads to testosterone release).
Disrupts the normally pulsatile release of LHRH - initially there is an increase in LH and then this followed by a decrease in both LH and testosterone.
This initial rise in LH can cause a transient increase in tumor volume (called a tumor flare) which can worsen symptoms if not blocked. Therefore we have to give androgen blocking drug such as Bicalutamide for the first few weeks to mask this (until the receptors become desensitised)
When we prescribe gosrelin why do we also need to give an androgen blocking drug (e.g. bicalutamide) for the first few weeks of treatment?
Causes an initial rise in LH can cause a transient increase in tumor volume (called a tumor flare) which can worsen symptoms if not blocked. Therefore we have to give androgen blocking drug such as Bicalutamide for the first few weeks to mask this (until the receptors become desensitized)
How do androgen blockers work?
Compete with DHT (dihydrotesterone, its active metabolite)
What is bicalutamide and goserelin?
Androgen blocking drugs
What is abiraterone? when is it used?
Oral androgen inhibitor for metastatic prostate cancer - licensed 1st line where chemotherapy is not yet clinically indicated.
Inhibits androgen production from testes, adrenal gland and prostate tumor cells.
What must also be prescribed with abiraterone?
Must be given a steroid (prednisolone 5mg BD) abriaterone is an irrversible inhibitor of CYP17A1, an enzyme responsible for androgen and cortisol production.
