Prostate Cancer (7) Flashcards
A man with BPH, poor urine stream, low back pain
- DRE was done and a firm, round prostate was felt, what’s your diagnosis?
BPH
What is the cause of prostate enlargement in BPH?
Androgens
What are the investigations for prostate cancer?
- PSA
- MSU analysis
- U&Es
How to take a prostate biopsy?
TRUS (transrectal ultrasound scan) guided from mid lobe parasagittal plane at the apex, the mid gland, and the base bilaterally
Why take multiple biopsies?
- Prostatic cancer can be focal, so it’s important to take samples from different sites
- There is often only a scant amount of tissue available for histologic examination in needle biopsies
- Malignant glands may be admixed with numerous benign glands
- The histologic findings pointing to malignancy may be subtle (leading to underdiagnoses)
- There are also benign mimickers of cancer that can lead to a misdiagnosis of cancer
How to differentiate between rectum and prostate cells in a needle biopsy?
- Using immunohistochemical marker (α-methylacyl-coenzyme A-racemase) (AMACR)
- CEA (in rectal cells)
What are the gene mutations involved in the pathogenesis of prostate cancer?
The most common acquired genetic lesions in prostatic carcinomas are TPRSS2-ETS fusion genes and mutations or deletions that activate the PI3K/AKT signaling pathway.
How to judge the success of radical prostatectomy?
Fall in the level of PSA below detectable levels within 4-6 weeks
Why is PSA not reliable?
- PSA is organ specific, but not cancer specific
- Although serum levels of PSA are elevated to a lesser extent in BPH than in prostatic carcinomas, there is considerable overlap
- Other factors such as prostatitis, infarction of nodular hyperplasia, instrumentation of the prostate, and ejaculation also increase serum PSA levels
What is the grading system for prostate tumors?
- Gleason score, grading prostate tumors from 2-10
- The pathologist allocates a number for the most common histological pattern in the specimen and does the same for the second most common pattern.
- The sum of these two numbers gives the Gleason score
What test can exclude bony metastasis?
Alkaline phosphatase
What kind of metastases occur in prostate cancer?
Sclerotic metastases
Why does sclerotic metastasis occur?
Due to increased bone deposition due to increased osteoblastic activity
Why did a patient post-operatively develop fever and dusky red urine?
UTI
Why is a patient post-operatively confused and has a raised white blood cell count?
UTI
