Prostate cancer

Question 1

What pathway is disrupted in most prostate cancers?

Answer 1

androgen-signalling pathway

Question 2

What is linked to familial prostate cancer?

Answer 2

inactivation of PTEN

Question 3

Which other gene is linked to prostate cancer?

Answer 3

BRCA 2

Question 4

What are the symptoms of prostate cancer?

Answer 4

problems with urination
back pain
haematuria
spread to other organs –> severe bone pain

Question 5

What are the majority of prostate cancer deaths due to?

Answer 5

metastatic disease

Question 6

What is the prostate?

Answer 6

exocrine gland that produces seminal fluid

Question 7

What is PSA?

Answer 7

component of seminal fluid

Question 8

What is blood PSA like normally?

Answer 8

undetectable

Question 9

What blood PSA level indicates possibility of prosthatic disease?

Answer 9

4ng/ml

Question 10

Why might benign prostate hyperplasia be problematic?

Answer 10

urethra constriction

Question 11

What are the other causes of raised PSA?

Answer 11

mechanical damage, prosthatitis

Question 12

What methods are used to grade tumours after positive PSA results?

Answer 12

biopsy + Gleeson scoring

Question 13

What gene appears to be increased in prostate cancers that subsequently metastasise?

Answer 13

EZH2

Question 14

What is the argument against routine PSA testing?

Answer 14

possibility that lesion, if left alone, would not be problematic in his lifetime –> causes anxiety/stress + invasive tests

Question 15

What are some treatments for prostate cancer?

Answer 15

radical prostatectomy
external beam radiotherapy
brachytherapy
hormone therapy

Question 16

What are some side effects of radical prostatectomy?

Answer 16

incontinence

impotence

Question 17

When is radical prostatectomy performed?

Answer 17

PSA < 12ng/ml

age < 70

Question 18

What is brachytherapy and when can it be used?

Answer 18

radioactive ‘seeds’ planted in prostate

used if tumour is contained to the prostate

Question 19

What are the side effects of radiotherapy?

Answer 19

incontinence, sexual dysfunction

Question 20

How does hormone therapy work?

Answer 20

LHRH analogue –> overstimulates LHRH receptor –> desensitised –> X LH + testosterone production

Question 21

When is external beam therapy be used?

Answer 21

When the cancer is not affecting other organs

Question 22

What are the side effects of hormone therapy?

Answer 22

osteoporosis
decreased libido
anaemia
muscle atrophy
memory loss

Question 23

What is a key change in prostate cancer progress?

Answer 23

change to androgen independence

Question 24

What is the evidence that the androgen receptor is required for prostate cancer progression?

Answer 24

even in androgen-independent tumours, androgen receptor expression is not lost, and often increased

Question 25

What are the possible causes for growth in the absence of circulating androgens?

Answer 25

amplified response to low residual levels of androgens

mutation of androgen receptor –> activated by other ligands

Question 26

How might the androgen pathway be bypassed altogether?

Answer 26

loss of PTEN