Prostate Cancer Flashcards
Where are most prostate cancers found?
Peripheral Zone
What are the stages of prostate cancer?
Localized
Locally Advanced
Metastatic
Hormone Refractory (i.e. resistant to castration)
Risk factors for Prostate Cancer?
1) Age
2) African/Afro-carribean
3) FH
4) High fat/processed carb diet
5) Some Drugs actually reduce risk e.g. Finasteride
How might a prostate cancer present?
- Weak stream
- Hesitancy
- Sensation of incomplete emptying
- Frequency : Not a lot of fluid a lot of times
- Urge incontinence : unintentional passing of urine due to overreactive bladder
- UTI
What symptoms would indicate an LOCALLY invasive prostate cancer?
If it comes with:
- Loin/perineal/suprapubic pain
- Impotence
- Haematuria or haemospermia
- Renal Failure
- Rectal Symptoms
What symptoms would indicate a metastatic prostate cancer?
If it comes with:
- Bone Pain or sciatica
- Spinal cord compression (Paraplegia)
- Lymph Node Enlargement
- Lymphoedema
- Loin pain/anuria (lymph nodes obstruct ureters)
- Lethargy due to anaemia or uraemia
- Weight loss & Cachexia
So a 65 yr old man presents with frequency, dysuria and slow to start urination. How would you confirm its prostate cancer?
A digital Rectal Exam (hard craggy prostate)
TRUS-guided biopsy (Transrectal US)
How do you stage Prostate Cancer?
Prostate Specific Antigen (PSA)
TRUS guided biopsy
CT pelvis, chest/abdo
MRI pelvis
What can cause an elevated PSA?
Upper limit increases with age
- UTI
- Chronic prostatits
- Instruments e.g. catheter
- Physiological e.g. ejaculation
- Recent urological procedure
- BPH!!
- Prostate Cancer!!
How is Prostate Cancer Treated?
Hormone Therapy:
- Alone
- Intermittent
- Followed by Surgery
- Followed by RT
Types of RT for prostate cancer?
External Beam RT
Brachytherapy (Radioactive material inserted directly into the site)
What are the major types of Hormone therapy?
Surgical castration (Bilateral Orchidectomy)
Chemical Castration with LHRH analogue
Anti-androgens
Oestrogens
How does chemical castration work?
LHRH analogue (e.g. goserelin) downregulates androgen receptors by -ve feedback. It causes the tumour to flare in the first wk so you need combined anti-androgens
How do anti-androgens work?
Inhibit androgen receptors on the Prostate
How do oestrogens treat prostate canceR?
1) Inhibit LHRH & Testosterone secretion
2) Inactivate Androgens
3) Direct cytotoxic effect on prostatic epithelium
