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Cancer Care > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

Give 4 risk factors for developing prostate cancer

A 
Increasing age
Androgens (rare if castrated < 40yo)
Black > White > Asian
Genetics - BRCA1+2
Folic acid supplements
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2
Q

What type of cancer is most common in the prostate and where is it likely to be?

A

Adenocarcinoma in the peripheral zone

can be TCC or neuroendocrine

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3
Q

What grading system is used for Prostate Cancer?

A

Gleason grading - assesses aggressiveness according to differentiation

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4
Q

How is the overall grade for prostate cancer worked out?

A

Primary grade - cells make up largest area
Secondary grade - cells make up 2nd largest area of tumour

Each grade 1-5

Add primary and secondary grade

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5
Q

Describe what is meant by each Gleeson grade between 1-5

A

1 - small uniform glands
2 - Increased stroma (space) between glands
3 - Infiltration of cells from glands at margins
4 - Irregular masses of neoplastic cells with few glands
5 - Lack of glands, sheets of cells

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6
Q

How does prostate cancer present?

A

normally asymptomatic as peripheral zone wont cause LUTS

LUTS - frequency, nocturia, poor stream, haematuria, retention

Invasive symptoms - UTI, impotence, haemospermia, AKI/CKD from obstruction, bone pain (mets)

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7
Q

What investigations are done for a patient with LUTS where prostate cancer is suspected?

A

DRE

PSA

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8
Q

What would constitute an abnormal DRE and PSA and what is done next?

A

DRE: hard, irregular, asymmetrical with loss of median sulcus
PSA: Generally >4 but some sources say >3

MRI is now first line (not TRUS with core biopsy)

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9
Q

Other than prostate cancer, what else can raise a PSA?

A 
Prostatitis
UTI
BPH
Retention 
Recent ejaculation
Iatrogenic: following a DRE or cystoscopy
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10
Q

Where can prostate cancer metastasise?

A

Bone
Adjacent Structures
Lymph

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11
Q

How and where specifically does prostate cancer metastasise to bone? What is the appearance of these boney lesions?

A

Via the Batson venous plexus to vertebral bodies to form sclerotic lesions

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12
Q

What adjacent structures can prostate cancer metastasise to?

A

Seminal vesicles
Bladder
Rectum

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13
Q

What lymph nodes does prostate cancer metastasise to?

A

obturator

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14
Q

What are the management options for prostate cancer

A 
Hormone Therapy
Radical Prostatectomy
Radiotherapy: external beam or brachy
Active surveillance 
Watchful waiting
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15
Q

Outline the hormone therapy options for prostate cancer

A

Surgical: bilateral orchidectomy
GnRH agonist (Goserelin)
Anti-androgen (cyproterone acetate)

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16
Q

What are the disadvantages of hormone therapy for prostate cancer?

A 
Hormone refractory disease eventually develop
Impotence
Decreased sexual desire
Hot flushes and sweats
Gynaecomastia
Loss of muscle mass

Testosterone flare (GnRH agonist - flare before fall)

17
Q

When does Testosterone flare happen and what symptoms do patients get?

A

When using GnRH agonists

bone pain +/- cord compression
bladder outlet obstruction can lead to AKI
fatal CVS events - hypercoagulable

18
Q

What occurs in a radical prostatectomy?

A

Open or Laparoscopic removal of entire prostate and seminal vesicles and obturator nodes

19
Q

What are the side effects of a prostatectomy?

A

Erectile dysfunction

Incontinence

20
Q

What are the side effects/risks of radiotherapy for prostate cancer?

A

Cystitis
Urethritis
Proctitis
Impotence

Increased risk of bladder and colorectal cancer

21
Q

What is brachytherapy?

A

Implant radioactive iodine seeds in the prostate using TRUS

22
Q

What advantages does brachytherapy have over external beam radiotherapy?

A

No systemic effects

23
Q

What is active surveillance with regards to prostate cancer?

A

Regular biopsies

Management option of choice for localised prostate cancers

24
Q

What is watchful waiting with regards to prostate cancer?

A

Done in frail men with complicated co-morbidities who wont survive treatment.

Monitoring less regular and in GP setting

25
Q

What are some complications of TRUS with core biopsy?

A 
Haematospermia
Prostatitis
Urinary sepsis
Urinary retention
Rectal bleeding
26
Q

Why is PSA not used in a national screening programme?

A

Not reliable
Doesn’t reduce deaths from cancer
Harm associated with over diagnosis

Cancer Care (25 decks)

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