prostate cancer

Question 1

The most commonest cell type of prostate cancer

Answer 1

adenocarcinoma

Question 2

Difference between BPH and prostate cancer

Answer 2

BPH more centrally on the prostate

Question 3

Grading used in prostate cancer

Answer 3

gleeson - scores tumours for 2 till 10 based on histologicla pattern of two most dominant areas eg. gleeson 4 then 3 is when the main area is 4 then the other area is stage 3

Question 4

Presentation of prostate cancer?

Answer 4

LUTS - nocturia, dribbing inc frequency impotence and poor stream (FINDS pms)

rectal exam enlarged hard cruggy gland

Question 5

bone complications in metastatic cancer

Answer 5

anaemia
pain
patholohical fracture
spinal cord compression

Question 6

INX in order

Answer 6

1. digital rectal exam and PSA
2. ISOTOPE RADIONUCLEOTIDE BONE SCAN
   - SEE bone involvement
3. mri
4. uss guided biopsy - not required if clinical suspicion high

Question 7

Which factors are considered into the management of prostate cancer

Answer 7

The exisiting medical co morbidities, age, current fitness level and according to this they will be counselled on what to do about the prostate cancer as it is a condition which people can live with for many years

Question 8

When is observation adviced and how does it work?

Answer 8

it is in patients with asymptomatic disease local and confined to the prostate active treatment only used in those whose mortality will be more than 10 years but the optimum managment is unknown

Question 9

Mangment of prostate cancer

Answer 9

surgery
radiotherapy
chemotherapy
hormonal treatment

Question 10

What surgery is used in localised disease (T2 or Less)

Answer 10

radical prostatectomy with curative intent performed by perineal or retroperineal routes

Question 11

Side effects of prostatectomy

Answer 11

impotence and incontience

Question 12

Benenfits of robotic surgery

Answer 12

shorter hospital stays, less blood loss shorter hospital stay mortality is low

Question 13

When is radical radiotherapy used

Answer 13

in T1 and T2 with a low pSA as it means mets are less likely and advanced local disease adjunvant radiorhapy can be given with surgery

Question 14

how long and why should adjuvant radiotherapy be delayed after transurethral resection of prostate

Answer 14

showuld be delayed 6 weeks following a transuretheral resection to prevent srtricture formationation

Question 15

what type of radiotherapy is used

Answer 15

external beam irradiation by institial implantation or radioisotopes (brachytherapy) or by a combination

Question 16

Side effets of radiation

Answer 16

dysuria rectal bleeding diahorrea incontience and impotennce

Question 17

When is palliative chem used

Answer 17

to palliate the primary tumour complications e.g. haeamturia and bone pain (recurrent haematuria due to bleeding from the prostate bed and bone pain from met disease)

Question 18

What are the diferent types of hormonal treatments

Answer 18

Lrhr 
gnrh 
oestorgen 
anti androgen therapy 
bilateral orchidectomy

Question 19

What is tumour flare and when does it occur and how is it avoided

Answer 19

triggered by the intitiation of LHRH and is avoided by short term androgen therapy

Tumour flare is when the symptoms initially increase can be associated with hypercalcemia or enlargement of tumour.

Question 20

Long term consequences of castration

Answer 20

increased cardiac risk and osteoporosis

Question 21

When and how are GNRH used and how is it given

Answer 21

GnRH - degarlix - causes high levels of testosterone same as if the patient was castrted. but it is not enough to cause tumour flare. It

is given by a subcutaneous injection monthyly

used when tumour flare can cause a oncology complciation such as met spinal cord compression

Question 22

What does is oestrogen therapy do

Answer 22

estorgen therapy - inhibit LRHR from the hypothalamus but are not good as high se- loss of libido, gynaecomastia, mi, stroke and pul emboli

Question 23

anti androgen and bilateral orchidectomy is used

Answer 23

anti-androgens - bicalutamide enzultamide - complete with andrigen for sites on the androgen receptor. enzulutamide used in combo with this in advanced prostate

bilateral orchidectomy - if people have little access ot medical therpay this is used

Question 24

When is LRHR used and what are the side effects

Answer 24

LHRH agonists (e.g. leuprorelin, goserelin - Leutenising hormone releasing hormone prevent testosterone being released as it will interfere with the pit gland - depot injections in SC or IM 3 monthly

side effects - impotence, loss of libido and tumour flare

Question 25

Which chemeotherapy is used

Answer 25

docetaxel and prednisolone and carazitaxel

Question 26

difference between GNRH and LHRH

Answer 26

lhrh leads to tumour flare but gonadotropin one doesnt therefore gnrh is recommended when risk of tumour flare will be life-threatening such as metastatic spinal cord compression- tumour flare would cause the tumour to grow more an imping on the cells even more.