Prostate cancer

Question 1

What are some of the causes of inc risk of prostate cancer

Answer 1

Heterogenous genetic disruption of androgen signalling pathway
Inactivation of PTEN which can lead to androgen independent activation of the androgen receptor
BRCA2

Question 2

What does the prostate do

Answer 2

provide components of the seminal fluid

Question 3

What are the symptoms of prostatic hyperplasia

Answer 3

Problems with urination
Lower back pain
Blood in urine

Question 4

Where does prostate cancer spread to

Answer 4

Seminal vesicles
Bladder
Lymph
Bone

Question 5

What is the major symptom of metastatic prostate cancer

Answer 5

severe bone pain

Question 6

Describe PSA

Answer 6

Component of seminal fluid that usually is prevented from entering tissue and serum due to epithelial gap junctions, basal cell layer and basement membrane.
Any damage to prostate allows PSA to escape and be detected

Question 7

What is the cutoff for serum PSA to indicate prostatic disease

Answer 7

4ng/ml

Question 8

What is the problem with the PSA test

Answer 8

Does not distinguish between benign or malignant

Question 9

What are other indications of a high PSA

Answer 9

mechanical damage

prostatitis

Question 10

How are biopsies conducted

Answer 10

needle biopsies

Need to have extended sampling techniques and repeat biopsies

Question 11

what is the problem with biopsies

Answer 11

not indicative of prognosis because you dont know how aggressive the tumour is

Question 12

What is the argument against PSA screening

Answer 12

raised PSA -> further invasive tests and acute anxiety
Malignancy will lead to treatment and unpleasant side effect and reduced quality of life
Unknown whether the lesion would be problematic

Question 13

What are the futures for prostate screening

Answer 13

specific for malignant disease
able to predict which will be life threatening
using bodily fluids

Question 14

What are the treatments for prostate cancer

Answer 14

Watchful waiting
Radical prostatectomy but incotinence and impotence
External beam radiotherapy if outside prostate capsule but no other organ- incontinence and sexual dysfunction
Metastatic: hormone therapy using a LHRH analogue
and anti androgens : osteoporosis, loss of libido, anaemia, muscle atrophy, memory loss, gynaecomastia

Question 15

What is androgen independence of cancer

Answer 15

Biochem relapse at 12 month
Symptomatic relapse 2 years
Expression of androgen receptor (ligand activated TF that mediates response to androgens) is inc by overexpression or gene amplification

Question 16

Why does prostate cancer continue to grow in the absence of circulating androgens

Answer 16

amplification of response to low residual levels of androgens by inc levels of androgen receptor, dec levels of co-repressors, mutations of androgen receptor causing it to be activated by other ligands

Question 17

When are mutations of the androgen receptor found

Answer 17

advanced metastatic hormone-independent disease