prostate cancer Flashcards
The most commonest cell type of prostate cancer
adenocarcinoma
Difference between BPH and prostate cancer
BPH more centrally on the prostate
Grading used in prostate cancer
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
Presentation of prostate cancer?
LUTS - nocturia, dribbing inc frequency impotence and poor stream (FINDS pms)
rectal exam enlarged hard cruggy gland
bone complications in metastatic cancer
anaemia
pain
patholohical fracture
spinal cord compression
INX in order
- digital rectal exam and PSA
- ISOTOPE RADIONUCLEOTIDE BONE SCAN
- SEE bone involvement - mri
- uss guided biopsy - not required if clinical suspicion high
Which factors are considered into the management of prostate cancer
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
When is observation adviced and how does it work?
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
Mangment of prostate cancer
surgery
radiotherapy
chemotherapy
hormonal treatment
What surgery is used in localised disease (T2 or Less)
radical prostatectomy with curative intent performed by perineal or retroperineal routes
Side effects of prostatectomy
impotence and incontience
Benenfits of robotic surgery
shorter hospital stays, less blood loss shorter hospital stay mortality is low
When is radical radiotherapy used
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
how long and why should adjuvant radiotherapy be delayed after transurethral resection of prostate
showuld be delayed 6 weeks following a transuretheral resection to prevent srtricture formationation
what type of radiotherapy is used
external beam irradiation by institial implantation or radioisotopes (brachytherapy) or by a combination
Side effets of radiation
dysuria rectal bleeding diahorrea incontience and impotennce
When is palliative chem used
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)
What are the diferent types of hormonal treatments
Lrhr gnrh oestorgen anti androgen therapy bilateral orchidectomy
What is tumour flare and when does it occur and how is it avoided
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.
Long term consequences of castration
increased cardiac risk and osteoporosis
When and how are GNRH used and how is it given
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
What does is oestrogen therapy do
estorgen therapy - inhibit LRHR from the hypothalamus but are not good as high se- loss of libido, gynaecomastia, mi, stroke and pul emboli
anti androgen and bilateral orchidectomy is used
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
When is LRHR used and what are the side effects
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
Which chemeotherapy is used
docetaxel and prednisolone and carazitaxel
difference between GNRH and LHRH
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.
