Prostate Cancer Flashcards
Age of patients diagnosed with prostate Ca
> 50Yrs
Incidence of prostate cancer
1 in 9 men
What are the hormones that drive prostate cancer
Testosterone. Testosteone is produced from testes and from androgens
What are the modifiable risk factors of prostate cancer?
Ocupational and exposures
Diets high if meats and fats
Describe the pathogenesis of cancer
A mutation develops in a key pathway - eg. proto-oncogene, tumour suppressor gene, DNA repair mechanisms. Over time more mutations develop in the cell, mutations themselves also lead to more mutations. Once the mutation burden has reached a threshold where control of growth is no longer possible cancer develops.
Signs and symptoms of prostate cancer
Unexplained weightloss Fatigue Urinary symptoms - retention, frequency, low volume Urinary tract infections Bone pain and fractures anaemia back pain spinal cord compression lower extremity oedema
Diagnosis process of prostate cancer
PSA - if raised continue or if high concern
rectal exam - even if normal could still have cancer
ultrasound with or without biopsy
Once confirmed with diagnosis then further imaging for staging (CT chest, abdo, pelvis, PET scan, bone scan)
Baseline blood tests
Sensitivity and specificity of PSA
80% sensitive, 70% specific aka bad test
What the staging systems are used for prostate cancer
Gleason score for prostate only - grades 1-5. This describes of degree of differentiation of the cells. 1 is cells that resemble prostate tissue, 5 are extremely abnormal.
TNM score - uses the tumour size and location, nodes and metastatic disease to grade into 1-4.
What is the prognosis of a stage 1-2 prostate cancer?
Almost 100% at 5 years
What are the hormonal targets of breast and prostate cancer?
Prostate cancer - androgens - use variety of antiandrogen treatments
Breast cancer - Oestrogen receptor and progesterone receptor
What is the goal of therapy in prostate cancer?
Depends on the stage of cancer and the patient. Curative intent for stages 1-3 - using combinations of surgery, radiotherapy, chemotherapy and hormonal therapy. Palliative for stage 4, patients not fit for other treatment options - radiotherapy, chemotherapy, hormonal therapy, supportive care
A surveillance approach can be taken at any state - prior to treatment to see if it is aggressive, after treatment, while on hormonal therapy
What is leuproelin? What are some of the other drugs similar to leuproelin?
A form of androgen deprivation. It is a GnRH agonist which works by stimulating GnRH release from the pituitary. This leads to an initial flare of the cancer followed by then shrinking as androgen production is decreased due to negative feedback. Other drugs in this class are goserelin and tiptoralin
Give 2 examples of a antiandrogen agent and describe their mechanism of action
Bicalutamide, flutamide, nilutamide, cyproterone. They completely inhibit AR preventing binding of testosterone
What form of treatment causes a flare of disease initially?
GnRH agonists. leuproelin, goserelin and tiptoralin
