Prostate Cancer Flashcards
Which conditions can lead to an increased PSA level?
Prostate cancer Recent DRE Infection Catheterisation Trauma
What are the current guidelines for prostate cancer screening?
Before taking test, discuss with patient if it’s going to be of any benefit
Test PSA between 50 and 70 years - no evidence for DRE
If PSA normal, test every 2 years
If PSA positive/abnormal DRE, refer to urologist and biopsy
How can a biopsy of the prostate be obtained?
Transrectal ultrasound (TRUS) guided biopsy MRI images and MRI guided biopsy may have role in salvage prostatectomy/repeat biopsy
Does a negative biopsy mean the patient is negative for prostate cancer?
No
As PSA has not been shown to be useful for screening, what better supported role does it serve in prostate cancer?
Ongoing management
What is a commonly used scoring system for prostate cancer?
Gleason score
In which condition can the Gleason score not be used?
Androgen deficiency
Has the genetic heterogeneity of prostate cancer been addressed?
Not yet
What sort of follow-up do patients with low risk prostate cancer require?
Surveillance
Prostatectomy
What is active surveillance?
For patients with low-moderate risk cancers
Don’t need to go for radical prostatectomy yet, but keep an eye on disease, as many prostate cancers are indolent
Because risk of surgery quite high
What does active surveillance in prostate cancer involve?
PSA
DRE
If gets worse, treat cancer
How can prostate cancer be staged?
Prostate specific Ag (PSA) imaging = radiolabel prostate specific Abs > bind to Ag throughout body > scan with CT
PET scan
What are some chemotherapies for prostate cancer, after resection?
Androgen deprivation therapy
LHRH agonists - medical castration - can control cancer for first 12-14 months
What are the three presentations of castrate sensitive prostate cancer?
De novo metastasis
Radical prostatectomy previously > metastasis
Well controlled previously on medical treatment > now metastatic
To what should treatment of prostate cancer be adapted?
Health status
What is the standard treatment of castrate sensitive prostate cancer?
Androgen deprivation therapy
Docetaxal
What is the treatment of castrate resistant prostate cancer?
Docetaxal
2nd line endocrine therapy
- Abiraterone
- Enzalutamide
What is the treatment for bony metastasis of prostate cancer?
Radium-223
What is the most common cancer in males?
Prostate cancer
What are the biggest cancer killers in males?
- Lung
- Colon
- Prostate
What is the 5-year survival of prostate cancer?
95%
What is the point of cancer screening?
Reduce mortality
Have an overall survival benefit
What are the risk factors for prostate cancer?
Age
African-American
FHx - BRCA1 and BRCA2 breast cancer
What is the interpretation of the Gleason score in prostate cancer?
6 = low risk 7 = intermediate risk 8-10 = high risk
Other than the Gleason score, what grading system is used in prostate cancer?
Epstein score
What are the CNS side effects of androgen deficiency therapy?
Cognitive change
Low mood
What are the cardiovascular side effects of androgen therapy?
Hypercholesterolaemia
IHD risk
Obesity
What are the side effects on bone of androgen deficiency therapy?
Osteoporosis
What are the general side effects of androgen deficiency therapy?
Lethargy
Reduced libido
Hot flushes
