Prostate cancer Flashcards by Maria Keriakos

What are the three modes of metastatic spread of prostate cancer?

lymphatic
haematogenous
transcoelomic

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What is transcelomic spread?

a route of tumour metastasis across a body cavity, such as the pleural, pericardial, or peritoneal cavity.

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What are the categories of symptoms that you can get with prostate cancer?

Systemic:

non-specific
specific
paraneoplastic symptoms

Local symptoms

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Give examples of non-specific constitutional symptoms in prostate cancer

weight loss
anorexia
fever
anaemia - normocytic

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Give examples of specific constitutional symptoms in prostate cancer

hypercalcaemia causing:

anorexia
thirst
confusion
collapse

marrow replacement causing:

purpura
anaemia
immune suppression

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Give examples of paraneoplastic symptoms that can be seen in prostate cancer

Endocrine:
- Cushing’s disease

neurological:
- dementia
- cerebellar degeneration
- peripheral neuropathy

dermatological:
acanthosis nigricans

haematological:
erythrocytosis

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What is the most common cancer in men?

prostate!

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What are the three most common cancers in men?

lung
bowel
prostate

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Which cancer causes the greatest number of deaths in men?

lung

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Which 3 cancers cause the greatest number of deaths in men?

lung
prostate
bowel

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What has the trend been for prostate cancer incidence?

it is on the rise

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What is the percentage of people who have a family history of prostate cancer who then go on to develop prostate cancer later in life?

10-15%

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What is the lifetime risk of diagnosis of prostate cancer?

12-16%

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advanced prostate cancer is life threatening T or F?

true

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localised prostate cancer is life threatening T or F?

false

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in which part of the prostate gland does prostate cancer develop?

peripheral zone

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in which part of the prostate gland does BPH develop?

transitional zone

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what proportion of people diagnosed with prostate cancer will die of prostate cancer?

1 IN 4 (may be 1 in 3)

localised prostate cancer presents with symptoms T or F?

FALSE - localised prostate cancer doesn’t present with any symptoms

what is the biological reason for increase of incidence in prostate cancer?

ageing popln

does FHx affect prostate cancer?

yes at greater risk of developing prostate caner if you have a first degree relative who had prostate cancer

what type of cancer is prostate cancer?

adenocarcinoma - as the prostate is a gland

is prostate cancer a single mass?

no - it is multifocal

where does prostate cancer metastasise to?

lymph nodes 
bone 
lung 
liver 
brain

which cancer classically mets to bone?

``` prostate thyroid breast kidney lung ```

what is the pathogenesis of prostate cancer?

TMPRSS2-ERG gene fusion prostate cancer is sensitive to androgens when these genes fuse, ERG is upregulated and ERG is an oncogene - results in loss of tumour suppressor genes and upregulation of oncogenes TMPRSS2 is also upregulated and when androgens bing to the androgen receptor on TMPRSS2 more serine protease is formed as TMPRSS2 normally produces a serine protease

what is PSA?

a serine protease responsible for liquefaction of semen

what is the most common reason for PSA increase?

BPE

how is prostate cancer diagnosed?

``` LUTS history PSA Transrectal ultrasound scan TRUSS prostate biopsy grading and staging of cancer after biopsy ```

what is the common grading system used for prostate cancer?

Gleason grading system

What is the difference between grade and stage of tumours?

grade = how aggressive the tumour is stage is how far the tumour has spread in the body can be correlated as a more biologically aggresssive disease will tend to spread quicker

what system is used to stage prostate cancer?

TNM as usual

what factors can predict mets in prostate cancer?

high grade high PSA what the prostate feels like

What are T1, T2 and T3 in prostate cancer?

T1 - no palpable tumour on DRE T2 - palpable tumour confined to prostate T3 - palpable tumour extending beyond prostate

How can we detect whether the prostate cancer has spread to lymph nodes

MRI scan | CT scan

how can we detect whether prostate cancer has spread to bone?

Technetium bone scan

what imaging can be offered before biopsy to increase the accuracy of the biopsy?

multi-parametric MRI scan

what are the treatment options for localised prostate cancer?

curative strategy ie: surgery - radical prostatectomy radiotherapy - external beam, brachytherapy adjuvant hormones focal therapy - high intensity ultrasound or active observation/watchful waiting

how is metastatic prostate cancer treated?

palliative with hormones

what are the arguments for radical treatment of localised prostate cancer?

curative treatment high mortality in prostate cancer reduced pt anxiety studies show benefit of surgery

what are the arguments against radical treatment of localised prostate cancer

disease of the elderly competing causes of death 30% of men with prostate cancer die of it but 70% don't adverse effects of treatment

How is locally advanced prostate cancer treated?

radiotherapy | radical prostatectomy

what is the first line treatment for metastatic disease?

medical castration ie orchiectomy | with docetaxel chemo

what other treatments are available for advanced prostate cancer apart from castration and chemo?

medical - GnRH analogues and LH antagonists | peripheral androgen receptor antagonists