Prostate Cancer Flashcards
Give 4 risk factors for developing prostate cancer
Increasing age Androgens (rare if castrated < 40yo) Black > White > Asian Genetics - BRCA1+2 Folic acid supplements
What type of cancer is most common in the prostate and where is it likely to be?
Adenocarcinoma in the peripheral zone
can be TCC or neuroendocrine
What grading system is used for Prostate Cancer?
Gleason grading - assesses aggressiveness according to differentiation
How is the overall grade for prostate cancer worked out?
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
Describe what is meant by each Gleeson grade between 1-5
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
How does prostate cancer present?
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)
What investigations are done for a patient with LUTS where prostate cancer is suspected?
DRE
PSA
What would constitute an abnormal DRE and PSA and what is done next?
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)
Other than prostate cancer, what else can raise a PSA?
Prostatitis UTI BPH Retention Recent ejaculation Iatrogenic: following a DRE or cystoscopy
Where can prostate cancer metastasise?
Bone
Adjacent Structures
Lymph
How and where specifically does prostate cancer metastasise to bone? What is the appearance of these boney lesions?
Via the Batson venous plexus to vertebral bodies to form sclerotic lesions
What adjacent structures can prostate cancer metastasise to?
Seminal vesicles
Bladder
Rectum
What lymph nodes does prostate cancer metastasise to?
obturator
What are the management options for prostate cancer
Hormone Therapy Radical Prostatectomy Radiotherapy: external beam or brachy Active surveillance Watchful waiting
Outline the hormone therapy options for prostate cancer
Surgical: bilateral orchidectomy
GnRH agonist (Goserelin)
Anti-androgen (cyproterone acetate)
What are the disadvantages of hormone therapy for prostate cancer?
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)
When does Testosterone flare happen and what symptoms do patients get?
When using GnRH agonists
bone pain +/- cord compression
bladder outlet obstruction can lead to AKI
fatal CVS events - hypercoagulable
What occurs in a radical prostatectomy?
Open or Laparoscopic removal of entire prostate and seminal vesicles and obturator nodes
What are the side effects of a prostatectomy?
Erectile dysfunction
Incontinence
What are the side effects/risks of radiotherapy for prostate cancer?
Cystitis
Urethritis
Proctitis
Impotence
Increased risk of bladder and colorectal cancer
What is brachytherapy?
Implant radioactive iodine seeds in the prostate using TRUS
What advantages does brachytherapy have over external beam radiotherapy?
No systemic effects
What is active surveillance with regards to prostate cancer?
Regular biopsies
Management option of choice for localised prostate cancers
What is watchful waiting with regards to prostate cancer?
Done in frail men with complicated co-morbidities who wont survive treatment.
Monitoring less regular and in GP setting
What are some complications of TRUS with core biopsy?
Haematospermia Prostatitis Urinary sepsis Urinary retention Rectal bleeding
Why is PSA not used in a national screening programme?
Not reliable
Doesn’t reduce deaths from cancer
Harm associated with over diagnosis
