Prostate cancer Flashcards
Definition
Most common malignancy affecting men in the UK
Who gets it
Elderly males
Black men
Where in the prostate is the commonest location for malignant prostate cancer?
Peripheral zone
- particularly the posterior lobe
Prostate cancer most commonly occurs in the centre/periphery of the prostate gland?
Periphery
Type (majority)
Multifocal adenocarcinoma
Clinical features
Asymptomatic LUTS Haematospermia Bone pain Anorexia Weight loss
Clinical exam
PR exam
- hard, craggy mass
Investigations
US
PSA
Trans-rectal US guided prostate biopsy
PSA
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
Give examples of non pathological elevations of PSA levels
Rectal exam
Cycling
Trans-rectal US guided prostate biopsy
Confirms diagnosis of prostate cancer
10 biopsies taken from the prostate
Which scoring system is used?
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
What is the most common pattern of malignant spread
To bones or lymph nodes
Prostate cancer is unique in that it has osteosclerotic/osteolytic bone properties?
Osteosclerotic
- most other cancers have osteolytic bone properties
Management - localised to prostate
Gleasons <6, PSA <10
Can leave alone and monitor patient
If pt wants treatment then offer
- radical prostadectomy
- radical radiotherapy
Management - locally advanced (outside prostate)
Gleasons 6-7, PSA 10-20
External beam radiotherapy + hormone therapy (LHRH agonist)
Brachytherapy
Management - metastatic disease
Gleasons 8-10, PSA >20
Androgen deprivation therapy (goserelin)
Hormone therpay (LHRH agonist)
Steroidal anti-androgens (cyproterone acetate)
What do LHRH agonists do?
Down-regulate testosterone production
LHRH agonist - side effects
Loss of libido
Erectile dysfunction
Hot flushes
Weight gain
