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Cancer - Vicki > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

What is the strongest risk factor for prostate cancer? What are other risk factors?

A

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).

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2
Q

What are the protective factors against prostate cancer?

A

Frequent ejaculation, >21 times per month, eating lots of tomatoes. Lycopenes.

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3
Q

Where does the prostate gland lie?

A

Below the bladder neck, anterior to rectum, traversed by the urethra. Normal function: produce the fluid in semen.

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4
Q

What type of cancer is prostate cancer?

A

Adenocarcinoma.

Metastasises to bone.

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5
Q

Where does prostate cancer spread to?

A

Bone.

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6
Q

How is prostate cancer graded?

A

TNM.

Gleason system.

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7
Q

How does prostate cancer usually present?

A

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.

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8
Q

How is PC diagnosed?

A

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.

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9
Q

What are normal levels of PSA?

A

0-4ng/ml

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10
Q

PSA levels of above what are associated with bony metastases?

A

> 50ng/ml

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11
Q

Are PSA levels increased in all men with prostate cancer?

A

No, up to 20% of men will not have raised PSA despite prostate cancer.

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12
Q

What is a TRUS?

A

Transurethral ultrasound - more accurate exam for staging prostate cancer.

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13
Q

Treatment options for PC consist of:

A 
Watchful waiting. 
Surgery - radical prostatectomy. 
Radiotherapy
Brachytherapy
Hormonal therpay
Chemotherapy
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14
Q

In what patients would radical prostatectomy be considered?

A

T1 or T2 disease who at least 10yr life expectancy.

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15
Q

What does radical prostatectomy involve?

A

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.

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16
Q

What are the benefits of radiotherapy over radical prostatectomy?

A

Less frequent impotence.

Used for symptom control in advanced disease as well.

17
Q

What is brachytherapy?

A

Radioactive pellets inserted into prostate gland. Similar efficacy and long term side effects to surgery or radiotherapy.

18
Q

What is the downside of hormonal therapies for PC?

A

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.

19
Q

What is the purpose of hormonal therapies?

A

Block the Androgen drive that sustains most prostate cancers.

20
Q

Testosterone from the testes is under the control of ________ ________ (LH) released from the ________ gland when stimulated by ____ from the ___________.

A

Testosterone from testes is under the control of luteinising hormone (LH) released from the pituitary gland when stimulated by LHRH from the hyporthalamus.

21
Q

What is bicalutamide?

A

Androgen blocking drug used during 1st few weeks during hormonal therapy.

22
Q

How can androgen blockade be achieved?

A

Testicular removal - bilateral orchidectomy.

LHRH analogues.

23
Q

Why are LHRH analogues used and what are some examples?

A

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.

24
Q

What is tumour flare?

A

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

25
Q

How do bicalutamide and cyproterone function as androgen blockers?

A

Compete with DHT at the receptor level within prostate cancer cells.

26
Q

What is maximal androgen blockade referring to?

A

The combination of a LHRH analogue and an anti-androgen drug - no proven benefit yet of such a combination.

27
Q

What is intermittent hormone therapy?

A

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.

28
Q

What are the main side effects of hormonal therapies for PC?

A 
Due to decreased testosterone levels:
Impotence
Loss of libido 
Gynaecomastia -> breast tenderness
Hot flushes
Depression & mood changes. 
Fatigue.
29
Q

What is Provenge?

A

Cancer vaccine for PC

Cancer - Vicki (12 decks)

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