Prostate cancer Flashcards
Function of the prostate
Makes seminal fluid that is stored in the seminal vesicles
Linked to what cancer in mother/sister?
Breast (BRCA link)
Who can request a PSA?
Men >50
5 signs of metastatic disease?
Anaemia
Lymphoedema
Malaise
Bone pain
Wt loss
What investigation is done at urology?
MRI guided transrectal biopsy
Risk with transrectal biopsy?
Bacteriaemia and death
Grading score used
Gleason score
How does gleason score work?
Look at biopsies
The cells present could be graded 1-5
1 and 2 ignored
The two most common tissue types are taken and used as two numbers to give the score.
e.g. if all were 3 then 3+3=6. If mostly 4, some 3 and a few 5 then 4+3=7
What are the best and worst gleason scores? How are they categorised?
6 lowest, 10 highest
6=low risk
7= intermediate risk
8-10 = aggressive
How is prostate cancer staged?
TNM
What is T1-4 in staging?
T1- biopsy only
T2- in prostate
T3- breaching capsule
T4- into rectum/bladder
How is overall risk done?
Combine gleason score, T (of TNM) and PSA
Low/int/high risk
Low risk- gleason <6, T 1c/2a, PSA <10
Intermediate risk- gleason 7, T2b/c, PSA 10-20
High risk- gleason >/=8, PSA>/=20
What is TX
The primary tumour cannot be evaluated.
At what stage would a tumour be felt on PR?
> T2
At what stage would a tumour be felt on PR?
> T2
What makes the cancer >/= T2b?
Involves more than half of 1 side of the prostate
Management options (local)
Robotic laparoscopic prostatectomy
RT
Brachytherapy
Active monitoring
Watchful waiting
Drawbacks of prostatectomy?
Risk impotence and incontinence
Infertile afterwards but can store sperm
How likely is it that a man might get impotence after prostatectomy?
Before having any treatment, 67% of men said they could get erections firm enough for intercourse. When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
How likely is it that a man might get urinary incontinence after prostatectomy?
1% of men said they used absorbent pads before having any treatment. When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
How likely is prostatectomy to cure the cancer?
For around 1 in 3 men, the cancer cells may not be fully removed and may return some time after the operation.
what must men do to prepare for their RT treatment each time?
Enema first and have a full bladder to minimise bladder and bowel damage and ensure prostate in same position.
Only actually takes 2-3 mins
Who is RT good for?
Older/co-morbs
what is the risk with RT
LT bowel probs
Who is brachytherapy good for
Fit, no-comorbs
Who should avoid brachytherapy?
Large prostate/significant urinary sx
How is brachytherapy done
US probe in rectum
GA 4 hours
Through perineum deliver radiation ± insert radioactive seeds
SE brachytherapy?
Significant urinary SEs (temporary)
Temporary SEs RT?
Diarrhoea
Soreness in the area
Loss of pubic hair
Tired
Cystitis
RT impotence stats?
67% of men said they could get erections firm enough for intercourse, decreasing to 22% after 6 months. Although this improved over the next 6 months, when asked again after 6 years, it had declined again to 27%.
RT likelihood of it returning?
1/3 same as prostatectomy
How do the brachytherapy SEs compare with RT?
the risk of urinary problems is higher
the risk of sexual dysfunction is the same.
The risk of bowel problems is slightly lower.
What is involved with active monitoring?
MRI annually, if change then biopsy ± ?treat, if not continue to monitor
What is watchful waiting and who gets it
Older men with co-morbs who you think will die of something else
No radical treatment
Maybe sx control
Advanced treatment options?
Androgen deprivation therapy -
- antiandrogen therapy,
- chemical castration,
- orchidectomy
Other systemic drugs (chemo or other)
Pallative RT for bone pain
What does anti androgen therapy do?
Prevents testosterone binding to receptors
e.g. flutamide
What is chemical castration
GnRH analogue- inhibits formation of LH in pituitary e.g. leuprorelin
SEs anti androgens
Hot flushes
Decrease sexual function/shrink genitals
Decreased muscle bulk and strength
Memory or mood disturbance
10% wt gain (central) –> risk DM
Osteoporosis and fracture risk
?CV risk
Where is prostate ca likely to spread?
Lymph and bones
Histological type of prostate ca?
Adenocarcinoma
