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Urology/Renal > Prostate cancer > Flashcards

Prostate cancer Flashcards

1
Q

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

A

lymphatic
haematogenous
transcoelomic

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2
Q

What is transcelomic spread?

A

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

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3
Q

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

A

Systemic:

  • non-specific
  • specific
  • paraneoplastic symptoms

Local symptoms

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4
Q

Give examples of non-specific constitutional symptoms in prostate cancer

A

weight loss
anorexia
fever
anaemia - normocytic

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5
Q

Give examples of specific constitutional symptoms in prostate cancer

A

hypercalcaemia causing:

  • anorexia
  • thirst
  • confusion
  • collapse

marrow replacement causing:

  • purpura
  • anaemia
  • immune suppression
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6
Q

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

A

Endocrine:
- Cushing’s disease

neurological:
- dementia
- cerebellar degeneration
- peripheral neuropathy

dermatological:
acanthosis nigricans

haematological:
erythrocytosis

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7
Q

What is the most common cancer in men?

A

prostate!

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8
Q

What are the three most common cancers in men?

A

lung
bowel
prostate

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9
Q

Which cancer causes the greatest number of deaths in men?

A

lung

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10
Q

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

A

lung
prostate
bowel

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11
Q

What has the trend been for prostate cancer incidence?

A

it is on the rise

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12
Q

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?

A

10-15%

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13
Q

What is the lifetime risk of diagnosis of prostate cancer?

A

12-16%

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14
Q

advanced prostate cancer is life threatening T or F?

A

true

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15
Q

localised prostate cancer is life threatening T or F?

A

false

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16
Q

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

A

peripheral zone

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17
Q

in which part of the prostate gland does BPH develop?

A

transitional zone

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18
Q

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

A

1 IN 4 (may be 1 in 3)

19
Q

localised prostate cancer presents with symptoms T or F?

A

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

20
Q

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

A

ageing popln

21
Q

does FHx affect prostate cancer?

A

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

22
Q

what type of cancer is prostate cancer?

A

adenocarcinoma - as the prostate is a gland

23
Q

is prostate cancer a single mass?

A

no - it is multifocal

24
Q

where does prostate cancer metastasise to?

A 
lymph nodes 
bone 
lung 
liver 
brain
25
Q

which cancer classically mets to bone?

A 
prostate 
thyroid 
breast 
kidney 
lung
26
Q

what is the pathogenesis of prostate cancer?

A

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

27
Q

what is PSA?

A

a serine protease responsible for liquefaction of semen

28
Q

what is the most common reason for PSA increase?

A

BPE

29
Q

how is prostate cancer diagnosed?

A 
LUTS history
PSA
Transrectal ultrasound scan TRUSS
prostate biopsy 
grading and staging of cancer after biopsy
30
Q

what is the common grading system used for prostate cancer?

A

Gleason grading system

31
Q

What is the difference between grade and stage of tumours?

A

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

32
Q

what system is used to stage prostate cancer?

A

TNM as usual

33
Q

what factors can predict mets in prostate cancer?

A

high grade
high PSA
what the prostate feels like

34
Q

What are T1, T2 and T3 in prostate cancer?

A

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

35
Q

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

A

MRI scan

CT scan

36
Q

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

A

Technetium bone scan

37
Q

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

A

multi-parametric MRI scan

38
Q

what are the treatment options for localised prostate cancer?

A

curative strategy ie:
surgery - radical prostatectomy
radiotherapy - external beam, brachytherapy
adjuvant hormones
focal therapy - high intensity ultrasound

or active observation/watchful waiting

39
Q

how is metastatic prostate cancer treated?

A

palliative with hormones

40
Q

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

A

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

41
Q

what are the arguments against radical treatment of localised prostate cancer

A

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

42
Q

How is locally advanced prostate cancer treated?

A

radiotherapy

radical prostatectomy

43
Q

what is the first line treatment for metastatic disease?

A

medical castration ie orchiectomy

with docetaxel chemo

44
Q

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

A

medical - GnRH analogues and LH antagonists

peripheral androgen receptor antagonists

Urology/Renal (14 decks)

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