Prostate Cancer Flashcards
What are the risk factors for prostate cancer?
Age (over 65) BRCA 2 Lynch Syndrome Family history Occupational exposure to pesticides Ethnicity - more common in black African men Obesity IGF-1 Vasectomy
Where does prostate cancer arise?
Peripheral prostatic glands
What histological type of prostate cancer is most common?
Adenocarcinoma
To where does prostate cancer spread?
Pelvic lymph,nodes
Bone
Via what structures does the prostate cancer spread to bone?
Tumour cells enter the subcapsular venous plexus and then the spinal venous system.
How does the median groove change in DRE from BPH to prostate cancer?
Exaggerated to obliterated
What structure is the barrier between cancer from the prostate getting to the rectum and vice versa?
Rectoprostatic fascia
What are the symptoms of prostate cancer?
Hesitancy Urgency Waking up in the middle of the night to pass urine Incontinence Frequency Blood in semen or Urine Erection problems
Describe the tumour staging for prostate cancer.
T1- tumour not palpable, asymptomatic/LUTS, too small to be seen on scan
T2 - tumour confined within prostate, nodular on examination
T3 - extension beyond the capsule, large hard irregular gland on DRE
T4 - fixed to neighbouring structures. Metastasis to rectum, bladder, pelvic wall or bone.
What symptoms may occur due to primary tumour or metastasis from prostate cancer?
Renal failure - occlusion of ureters
Patients with nodal disease may have symptoms of local compression (swollen leg) and impaired lymphatic drainage (penile and genital oedema)
Bone pain, pathological fractures, MSCC
Changes in bowel habits
What would you do for a Male aged 67 presenting to GP with back ache and difficulty passing urine?
DRE
PSA
What PSA level is indicative of prostate cancer?
10-15 nanograms/ml - if infection is excluded
What are the different types of prostate biopsy?
TRUS (trans-rectal USS) guided biopsy
Template biopsy
What are the potential side effects of a TRUS and template biopsy?
Pain Bleeding Infection - more likely in TRUS Acute urine retention - more likely in template Short term erectile dysfunction
List the causes of a raised PSA, other than prostate cancer
Urine infection Vigorous exercise Ejaculation DRE Anal sex Prostate biopsy Catheterisation Inflammation Severe constipation
What is worked out when examining the prostate biopsies under the microscope?
Gleason score = most common grade in all samples + highest grade in the other samples
Grading system: 1 and 2 are not cancer. 3, 4 and 5 are cancer.
What is the purpose of the Gleason score?
Indicator of how aggressive the cancer is - how likely it is to grow and metastasise. This informs treatment options.
What are the treatment options for prostate cancer?
Active surveillance Watchful waiting Surgery - radical prostatectomy External Beam Radiotherapy Permanent Seed Brachytherapy Hormone therapy
What connects the subcapsular venous plexus to the vertebral venous plexus?
Batson venous plexus
Summarise the TRUS process
USS probe with gel in back passage
Injection of local anaesthetic to numb the area
Needle placed next to probe and goes through wall of the back passag
10-12 samples of tissue
10-15 minutes
Summarise the process of a template biopsy
Needles inserted through perineum (skin between testicles and rectum)
Needles pass through a grid template
30-50 samples
Done under GA or spinal block
Why might someone have a template biopsy rather than a TRUS biopsy?
TRUS biopsy did not show cancer but doctor still suspects
Contraindications e.g. other health problem
What investigation should be considered for men with negative TRUS 10-12 core biopsy to determine whether another biopsy is needed?
MRI
Other than an MRI or CT to investigate a patient’s T or N stage, what other investigation might be required?
Radionucleotide bone scan - sclerotic bony metastases (dense, appear white on x-ray)
