Prostate cancer

Question 1

What are RF for prostate cancer

Answer 1

Strong FHx

+/- environmental factors, diet, high serum testosterone

Question 2

How is prostate cancer related to hormones

Answer 2

Cancer responds to hormonal deprivation

Men castrated before puberty cant get prostate cancer

Question 3

What are S/Sx of prostate cancer

Answer 3

Early: none
Late: +/- obstructive Sx
Later: Metastatic Sx

Question 4

What are general principles of a DRE

Answer 4

Any hard nodule needs to be biopsied

If questionable, correlate nodule with PSA

Question 5

On a DRE we are looking for

Answer 5

prostate
blood in stool
rectal cancer

Question 6

How to preform a DRE

Answer 6

Kneeling position (good for appx size of gland and cancer not ID by other methods)
Buttocks separated
Index finger
base of prostate palpation

Question 7

What is PSA (prostate specific antigen)

Answer 7

Serine protease produced by epithelial cells lining acini and ducts of prostate
Most secreted in seminal fluid (little enters circulation)
Different than PAP (prostatic acid phosphatase)
Can help ID cancer not detected by DRE

Question 8

Is PSA specific to prostate cancer

Answer 8

No, found in normal prostatic tissue, BPH, primary, and metastatic prostate cancer

• Acute urinary retention
• Prostatitis
• Prostate infarction
• Prostatic intraepithelial neoplasia
• Catheterization

Question 9

Can you check PSA after a DRE

Answer 9

Yes, median increase in PSA after a DRE is insignificant

But dont do a prostate massage!

Question 10

What is PSA velocity

Answer 10

change in PSA over time

can detect early prostate cancer

Question 11

What is PSA density

Answer 11

Serum PSA/ Prostate volume

>1.5 is significant and can help differentiate BPH from prostate cancer

Question 12

What genomic testing is available for prostate cancer

Answer 12

PCA3

4K score

Question 13

What MRI’s can you do for prostate cancer

Answer 13

Multiparametric
PI-RADS score
Targeted fusion biopsy
-Transrectal US/ biopsy

Question 14

What are the symptoms of mets

Answer 14

bone pain 
weight loss
anemia
azotemia (high nitrogen) 
fatigue
dyspnea
lymphedema 
ureteral obstruction

Question 15

What tests can you run to eval mets

Answer 15

Nuclear bone scan
CT A/P
PET scan (black is cancer)

Question 16

What are your Tx options for prostate cancer

Answer 16

surgery
radiation (external beam or seed implantation)
hormone manipulation
observation

Question 17

What is a radical prostatectomy

Answer 17

removal of prostate for lesions confined to prostate

Decreased morbidity with robot assist

Question 18

What are complications of a radical prostatectomy

Answer 18

impotence
bladder neck contracture
incontinence

Question 19

What is hormonal manipulation

Answer 19

Treatment invented in 1941
objective tumor regression measured by bone scan, CT, and PSA
B/l orchiectomy, LH-RH analogs, or antiandrogens

Question 20

Where is testosterone made

Answer 20

in the testicles and adrenals

Question 21

What are the LH-RH analogs an dhow do they work

Answer 21

Leuprolide, Goserelin

After 7 days, Leuprolide tells hypothalamus to stop releasing LH= decreased testosterone production

Question 22

ADE of LH-RH analogs are

Answer 22

diarrhea
n/v
peripheral edema 
gynecomastia 
hot flashes

Question 23

What do anti-androgens do

Answer 23

They block the androgen receptors so DHT cant bind

Question 24

What are castrate resistant cancer Tx

Answer 24

Abiraterone 
Enzalutamide 
Sipuleucel-T 
Docetaxel 
Cabazitaxel 
Radium-223