Prostate cancer Flashcards
What is the transitional zone of the prostate?
surrounds the prostatic urethra
gives rise to BPH
What is the central zone of the prostate?
cone shaped around the ejaculatory ducts
What is the peripheral zone of the prostate?
origin of up to 70% prostate adenocarcinomas
Where in the world has the highest stats of prostate cancer?
western world
black>Caucasian
What genes may be mutated in prostate cancer?
chromosome 1q, 8p, Xp and BRACA2 gene
What is the general presentation of prostate cancer?
lower urinary tract symptoms haematuria haematospermia bone pain weight loss
How are prostate cancers diagnosed?
PR and PSA levels
What are the PR findings of prostate cancer?
asymmetry, nodule, craggy
What is PSA?
a glycoprotein - kallikrein like serine protease
produced by the secretory epithelium of the prostate glands
What is the role of PSA?
liquification of semen
What are the normal levels of semen and serum PSA?
semen levels = high
serum levels = low
What causes a raised PSA?
anything that causes inflammation
What should be done if there is an abnormal PR exam and increased PSA?
trans rectal USS guided prostate biopsy - 10 biopsys taken
What type of cancers are >95% of prostate cancers?
adenocarcinomas
Where do prostate cancers usually mestesise to?
pelvic lymph nodes
bones - sclerotic lesions
How are prostate cancers graded?
Gleasons Scoring
How are organ confined prostate cancers treated?
watchful waiting
surgery - prostatectomy
radiotherapy
How are locally advanced prostate cancers treated?
radiotherapy with Neo-adjuvant hormonal therapy
How are metastatic prostate cancers treated?
androgen deprivation therapy - anti androgens, LHRH analogues
bilateral subcapsular orchidectomy
steroids
cytotoxic chemo
What is growth of prostate cancer cells under the influence of?
testosterone and dihydrotesterone
What is the role of hormonal LHRH analogues?
cause a down expression of LHRH receptors which suppress pituitary LH and FSH secretion and therfore tesosterone production
What are the side effects of hormonal LHRH analogues?
spinal cord compression weight gain hot flushes osteoporosis loss of libedo ED
What are the roles of antiandrogens?
compete with testosterone and DHT for binding sites on their receptors in the prostate cell nucleus - which promotes apoptosis and CaP growth
What is a risk factor for prostate cancer?
cadmium batteries
Do the most aggressive nasty prostate cancers produce PSA?
no!
What is benign prostatic hyperplasia?
hypertrophied detrouser muscle and enlarged prostate = obstructed urinary flow
