Prostate Cancer Flashcards
What is the most common cancer in men?
Prostate cancer
How is prostate cancer usually diagnosed?
Usually diagnosed after a PSA test coming back as elevated. MAny men with prostate cancer die due to other causes, the cancer does not cause their death. Most prostate cancers are either localised or locally advanced when diagnosed.
What is the main type of prostate cancer?
Adenocarcinoma
Others include transitional cell carcinoma (transitional cell carcinoma) or small cell prostate cancer (arises from neuroendocrine cells)
What zone of the prostate do prostate cancers generally arise from?
Posterior peripheral zone
What are risks factors for prostate cancer?
Increasing age Afro-caribbean ethnicity (associated with earlier development) Family history of prostate cancer Obesity BRCA1 and BRCA2
What are some symptoms of prostate cancer?
Early on causes minimal symptoms LUTS- Urgency, poor stream, hesitancy, inability to completely empty bladder (retention), most micturition dribble, painful urination, nocturia Painful ejaculation Haematuria- visible or invisible If mets to bone- lower back/pelvic pain
What investigations would you do if you suspect a patient has prostate cancer?
Digital rectal examination
PSA level
Secondary care- Transrectal US guided biopsy, MRI
ALP- If suspicion bone mets, Bone Isotope scanning should be done to investigate for bony metastases.
What system is used to grade prostate cancers?
Gleason Score- scored out of 10 based on how poorly differentiated cells are. This requires a tissue biopsy which is obtained via tran-rectal USS.
How are prostate cancers staged?
Using the TNM system- Imaging is required to investigate for metastases or nodal involvement. CT or MRI.
What factors do NICE recommend are used to score the risk of prostate cancer?
Prostate cancers are defined as high, medium or low risk using PSA levels, Gleason Score and Staging using TNM system (uses the T stage)
Who should be referred urgently using a 2 week wait for suspected prostate cancer according to NICE guidance?
Anyone with a malignant feeling prostate on DRE
PSA levels above age specific range
Consider a PSA test and DRE for anyone with LUTS (nocturia, urgency, hesitancy, poor stream, post-micturition dribble, increased frequency or urination), Erectile dysfunction or haematuria
What are the age specific ranges for PSA?
40-49- Less than 2
50-59- Less than 3
60-69- Less than 4
70 or older- Less than 5
What else can cause PSA levels to be raised?
Acute urinary retention Prostatitis Recent catheterisation TURP BPH Increases anyway with age UTI
What should happen for patients with a raised PSA?
They should be offered a biopsy. This is transrectal ultrasound guided biopsy
Does a normal or low PSA rule out prostate cancer?
No it doesn’t- around 15% of men with prostate cancer do not have a raised PSA
A patient has recently been diagnosed with prostate cancer, what are the treatment options?
Active surveillance- regular PSA and DRE. Repeat biopsy at 12 months. Many men with prostate cancer do not die from it. Consider for men who do not want surgery or radiotherapy
Surgery- Radical prostatectomy with curative intent. Can be done laparoscopically or using da-vinci robot.
Radiotherapy
Hormone Therapy
Note currently recommended by NICE- High Intensity Focussed Ultrasound, Cryotherapy
What radiotherapy options are used in the treatment of prostate cancer?
External beam radiotherapy- directs high energy X-rays at the tumour to induce DNA damage and kill the cancerous cells. Often combined with hormone therapy.
High Dose-Rate Brachytherapy- Source of radiation delivered into the tumour to cause local DNA damage, may be combined with external beam
Note- Radiotherapy can also be used palliatively to reduce symptoms
Outline the hormone treatments that may be used in the treatment of prostate cancer?
Testosterone drives the growth of prostate cancer- not curative (may be combined with other treatments) but does reduce the rate of prostate cancer growth
LHRH Agonists e.g. Goserelin, Triptorelin - Reduce the production of testosterone. Initially they cause an increase in testosterone production so anti-androgens are given (this is called a flare)
Antiandrogens e.g. Flutamide, Bicalutamide- Block the effects of testosterone
Orchiectomy also reduces testosterone production but not commonly done.
How does Goserelin work?
This is a Luteinizing Hormone Releasing Hormone Agonist or Gonadotropin releasing hormone agonist. Initially it causes a surge of testosterone (called a flare, give anti-androgen such as Flutamide) but then there is down regulation of the LHRH receptors and reduced testosterone stimulation.
