Prostate cancer Flashcards

1
Q

Definition

A

Most common malignancy affecting men in the UK

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2
Q

Who gets it

A

Elderly males

Black men

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3
Q

Where in the prostate is the commonest location for malignant prostate cancer?

A

Peripheral zone

- particularly the posterior lobe

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4
Q

Prostate cancer most commonly occurs in the centre/periphery of the prostate gland?

A

Periphery

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5
Q

Type (majority)

A

Multifocal adenocarcinoma

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6
Q

Clinical features

A
Asymptomatic
LUTS 
Haematospermia 
Bone pain
Anorexia
Weight loss
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7
Q

Clinical exam

A

PR exam

- hard, craggy mass

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8
Q

Investigations

A

US
PSA
Trans-rectal US guided prostate biopsy

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9
Q

PSA

A

Protein specific antigen

  • prostate specific marker
  • it is NOT always positive in some people with prostate cancers
  • PSA < 10 = low risk cancer
  • PSA 10-20 = mod risk cancer
  • PSA > 20 = high risk cancer
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10
Q

Give examples of non pathological elevations of PSA levels

A

Rectal exam

Cycling

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11
Q

Trans-rectal US guided prostate biopsy

A

Confirms diagnosis of prostate cancer

10 biopsies taken from the prostate

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12
Q

Which scoring system is used?

A

Gleasons

  • 1-5 scoring system
  • score increases with loss of glandular structure
  • score < 6 = low risk
  • score 6-7 = mod risk
  • score 8-10 = high risk
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13
Q

What is the most common pattern of malignant spread

A

To bones or lymph nodes

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14
Q

Prostate cancer is unique in that it has osteosclerotic/osteolytic bone properties?

A

Osteosclerotic

- most other cancers have osteolytic bone properties

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15
Q

Management - localised to prostate

A

Gleasons <6, PSA <10
Can leave alone and monitor patient

If pt wants treatment then offer

  • radical prostadectomy
  • radical radiotherapy
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16
Q

Management - locally advanced (outside prostate)

A

Gleasons 6-7, PSA 10-20
External beam radiotherapy + hormone therapy (LHRH agonist)
Brachytherapy

17
Q

Management - metastatic disease

A

Gleasons 8-10, PSA >20
Androgen deprivation therapy (goserelin)
Hormone therpay (LHRH agonist)
Steroidal anti-androgens (cyproterone acetate)

18
Q

What do LHRH agonists do?

A

Down-regulate testosterone production

19
Q

LHRH agonist - side effects

A

Loss of libido
Erectile dysfunction
Hot flushes
Weight gain