Prostate Cancer Flashcards
What is the strongest risk factor for prostate cancer? What are other risk factors?
Age.
Black men more at risk.
2-3fold increase in risk if relative affected.
Androgens increases risk.
Diet high in fat and red meat.
Protective factors: frequent ejaculation, diet high in lycopenes (tomates).
What are the protective factors against prostate cancer?
Frequent ejaculation, >21 times per month, eating lots of tomatoes. Lycopenes.
Where does the prostate gland lie?
Below the bladder neck, anterior to rectum, traversed by the urethra. Normal function: produce the fluid in semen.
What type of cancer is prostate cancer?
Adenocarcinoma.
Metastasises to bone.
Where does prostate cancer spread to?
Bone.
How is prostate cancer graded?
TNM.
Gleason system.
How does prostate cancer usually present?
Similar to BPH.
Lower urinary tract symptoms: hesitancy, dribbling, reduced void pressure, frequency increase, urgency increase nocturia.
1/3 pts present with symptoms from locally invasive or metastatic disease.
Haematospermia.
How is PC diagnosed?
Digital rectal examination.
T1 cancer not detectable via this.
PSA (prostate specific antigen) - glycoprotein secreted by prostatic cells to aid liquification of semen.
Normal levels = 0-4ng/ml. Leaks through cancer cell membrance into circulation.
What are normal levels of PSA?
0-4ng/ml
PSA levels of above what are associated with bony metastases?
> 50ng/ml
Are PSA levels increased in all men with prostate cancer?
No, up to 20% of men will not have raised PSA despite prostate cancer.
What is a TRUS?
Transurethral ultrasound - more accurate exam for staging prostate cancer.
Treatment options for PC consist of:
Watchful waiting. Surgery - radical prostatectomy. Radiotherapy Brachytherapy Hormonal therpay Chemotherapy
In what patients would radical prostatectomy be considered?
T1 or T2 disease who at least 10yr life expectancy.
What does radical prostatectomy involve?
Removal of prostate and seminal vesicles and sometimes pelvic lymph nodes: impotence in 30-70%, only performed in potentially curative setting.
85% disease-free survival at 10yrs.
What are the benefits of radiotherapy over radical prostatectomy?
Less frequent impotence.
Used for symptom control in advanced disease as well.
What is brachytherapy?
Radioactive pellets inserted into prostate gland. Similar efficacy and long term side effects to surgery or radiotherapy.
What is the downside of hormonal therapies for PC?
Rapid response to initial treatment however this onyl lasts for 2 years, after which no response. Most patients die within 2 years of development of hormone-refractory PC.
What is the purpose of hormonal therapies?
Block the Androgen drive that sustains most prostate cancers.
Testosterone from the testes is under the control of ________ ________ (LH) released from the ________ gland when stimulated by ____ from the ___________.
Testosterone from testes is under the control of luteinising hormone (LH) released from the pituitary gland when stimulated by LHRH from the hyporthalamus.
What is bicalutamide?
Androgen blocking drug used during 1st few weeks during hormonal therapy.
How can androgen blockade be achieved?
Testicular removal - bilateral orchidectomy.
LHRH analogues.
Why are LHRH analogues used and what are some examples?
They disrupt normal pulsatile release of LHRH.
Initially the levels of LH increase followed by a decrease in LH and testosterone. The initial increase in LH can cause a transient increase in tumour volume = tumour flare = worsen symptoms if not blocked. Hence the need to give an androgen blocking drug.
What is tumour flare?
Initially ↑ LH
release followed by ↓ LH & testosterone. Initial ↑ LH
can cause transient increase in tumour volume (=
tumour flare) which can worsen symptoms if not
blocked therefore we give androgen blocking drug e.g.
bicalutamide for 1st few wks
How do bicalutamide and cyproterone function as androgen blockers?
Compete with DHT at the receptor level within prostate cancer cells.
What is maximal androgen blockade referring to?
The combination of a LHRH analogue and an anti-androgen drug - no proven benefit yet of such a combination.
What is intermittent hormone therapy?
Based on the theory that withdrawal of LHRH analogue may allow the growth of hormone-sensitive cells within the tumour which can be treated again as PSA or symptoms dictate.
What are the main side effects of hormonal therapies for PC?
Due to decreased testosterone levels: Impotence Loss of libido Gynaecomastia -> breast tenderness Hot flushes Depression & mood changes. Fatigue.
What is Provenge?
Cancer vaccine for PC
