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Cancer Care > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

What are the risk factors for prostate cancer?

A 
Age (over 65)
BRCA 2
Lynch Syndrome 
Family history
Occupational exposure to pesticides 
Ethnicity - more common in black African men
Obesity
IGF-1
Vasectomy
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2
Q

Where does prostate cancer arise?

A

Peripheral prostatic glands

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3
Q

What histological type of prostate cancer is most common?

A

Adenocarcinoma

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4
Q

To where does prostate cancer spread?

A

Pelvic lymph,nodes

Bone

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5
Q

Via what structures does the prostate cancer spread to bone?

A

Tumour cells enter the subcapsular venous plexus and then the spinal venous system.

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6
Q

How does the median groove change in DRE from BPH to prostate cancer?

A

Exaggerated to obliterated

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7
Q

What structure is the barrier between cancer from the prostate getting to the rectum and vice versa?

A

Rectoprostatic fascia

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8
Q

What are the symptoms of prostate cancer?

A 
Hesitancy
Urgency
Waking up in the middle of the night to pass urine
Incontinence
Frequency
Blood in semen or Urine 
Erection problems
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9
Q

Describe the tumour staging for prostate cancer.

A

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.

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10
Q

What symptoms may occur due to primary tumour or metastasis from prostate cancer?

A

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

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11
Q

What would you do for a Male aged 67 presenting to GP with back ache and difficulty passing urine?

A

DRE

PSA

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12
Q

What PSA level is indicative of prostate cancer?

A

10-15 nanograms/ml - if infection is excluded

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13
Q

What are the different types of prostate biopsy?

A

TRUS (trans-rectal USS) guided biopsy

Template biopsy

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14
Q

What are the potential side effects of a TRUS and template biopsy?

A 
Pain
Bleeding
Infection - more likely in TRUS
Acute urine retention - more likely in template 
Short term erectile dysfunction
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15
Q

List the causes of a raised PSA, other than prostate cancer

A 
Urine infection
Vigorous exercise 
Ejaculation 
DRE
Anal sex
Prostate biopsy 
Catheterisation
Inflammation 
Severe constipation
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16
Q

What is worked out when examining the prostate biopsies under the microscope?

A

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.

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17
Q

What is the purpose of the Gleason score?

A

Indicator of how aggressive the cancer is - how likely it is to grow and metastasise. This informs treatment options.

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18
Q

What are the treatment options for prostate cancer?

A 
Active surveillance
Watchful waiting
Surgery - radical prostatectomy 
External Beam Radiotherapy 
Permanent Seed Brachytherapy
Hormone therapy
19
Q

What connects the subcapsular venous plexus to the vertebral venous plexus?

A

Batson venous plexus

20
Q

Summarise the TRUS process

A

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

21
Q

Summarise the process of a template biopsy

A

Needles inserted through perineum (skin between testicles and rectum)
Needles pass through a grid template
30-50 samples
Done under GA or spinal block

22
Q

Why might someone have a template biopsy rather than a TRUS biopsy?

A

TRUS biopsy did not show cancer but doctor still suspects

Contraindications e.g. other health problem

23
Q

What investigation should be considered for men with negative TRUS 10-12 core biopsy to determine whether another biopsy is needed?

A

MRI

24
Q

Other than an MRI or CT to investigate a patient’s T or N stage, what other investigation might be required?

A

Radionucleotide bone scan - sclerotic bony metastases (dense, appear white on x-ray)

25
Q

What are the side effects/risks of a prostate biopsy?

A 
Infection - more likely in TRUS
Acute urine retention - more likely in template
Bleeding
Pain
Erectile dysfunction (short term)
26
Q

What are the criteria for high-risk prostate cancer?

A

PSA (ng/ml): >20
Gleason score: 8 - 10
Clinical stage: T2c

27
Q

What is the criteria for low-risk prostate cancer?

A

PSA: <10ng/ml
Gleason score: 6 or less
Clinical stage T1 - T2a

28
Q

What is active surveillance?

A

Monitoring slow-growing prostate cancer, rather than treating it straight away.

29
Q

Why is active surveillance chosen over immediate treatment?

A

Avoid unnecessary treatment

Delay possible side effects

30
Q

For what patients is active surveillance indicated for?

A

Low-risk
Consider for intermediate and high risk localised prostate cancers if the patient does not want to have immediate radical treatment (prostatectomy or radiotherapy).

31
Q

What is radical treatment for prostate cancer?

A

Radical prostatectomy

Radical radiotherapy

32
Q

Describe what happens to a patient enrolled in active surveillance

A

They will have a multiparametric MRI if this has not previously been performed.
In the first year PSA is measured every 3-4 months and DRE every 6-12 months.
At one year, prostate rebiospy.

33
Q

For what type of patients is active surveillance particularly suitable for?

A

Patients with other life threatening comorbidities

34
Q

What is meant by watchful waiting?

A

Monitoring prostate cancer that isn’t causing any symptoms or problems.

35
Q

What is TURP?

A

Transurethral Resection of the Prostate
Operation to remove parts of the prostate pressing on the urethra.
Performed for any persistent bladder obstruction due to an enlarged prostate.

36
Q

For what patients would radical prostatectomy be potentially curative and why?

A

Stage T1 and T2

Cancer is confined to the prostate

37
Q

What are the risks of radical prostatectomy?

A

Impotence

Incontinence

38
Q

What is the recommended treatment for locally advanced disease (T3 or T4, N0, M0)?

A

Radical treatment - combination of radical radiotherapy and androgen deprivation therapy

39
Q

What is the recommended treatment for metastatic prostate cancer?

A

Hormone therapy (androgen deprivation)

40
Q

How long will patients with locally advanced prostate cancer generally receive hormone therapy for?

A

3 years post radiotherapy for men with high-risk localised prostate cancer.

41
Q

Outline the hormone therapies used in prostate cancer.

A

Goserelin - LHRH agonist
Bicalutamide - AR antagonist
Degarelix - GnRH antagonist: advanced cancer that has spread to the bones
Enzalutamide - AR antagonist and AR signalling inhibitor: metastatic castrations resistant prostate cancer

42
Q

What chemotherapy is an option for men with hormone refractory prostate cancer?

A

Docetaxel - Taxane that inhibits microtubule structures within the cell

43
Q

What is the criteria for referral of men via the urgent 2ww cancer pathway?

A

Prostate feels malignancy on DRE

PSA levels are above age-specific reference range

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