Prostate cancer Flashcards
How many men will be diagnosed with prostate cancer in their lifetime?
1/8
What type of hormone affects the growth of prostate cancer?
Androgens
What type of cancer are prostate cancer usually?
Adenocarcinomas
Where is the prostate does cancer usually develop?
Peripheral zone
Prostate cancer is usually multifocal, what does this mean?
Arising from two or more places
What are the two types of adenocarcinoma of the prostate?
Acinar adenocarcinoma and Ductal adenocarcinoma
What is a acinar adenocarcinoma?
originated in the glandular cells that line the prostate gland- most common
What is a ductal adenocarcinoma?
Originates in the cells that line the ducts of the prostate gland- tends to metastasise faster
What are the risk factors for prostate cancer?
Age, Black African or Caribbean, Family history, BRACA2 or 1, obesity, diabetes, smoking, less exercise
What are the clinical features of prostate cancer?
LUTS
Haematuria, dysuria, incontinence, haematospermia, suprapubic pain, loin pain, rectal tenesmus, bone pain, lethargy, anorexia, unexplained weight loss
What examination is essential in the diagnosis of prostate cancer?
DRE as most cancers arise from the posterior peripheral zone, looking for asymmetry, modularity, fixed irregular mass
What are the differential diagnosis for prostate cancer?
BPH, Prostatitis, bladder cancer, urinary cancer, urinary stones, UTI, pyelonephritis
What antigen would you test for?
Prostate specific antigen
Other than prostate cancer what can raise PSA?
BPH, Prostatitis, vigorous exercise, ejaculation, recent DRE
What calculations can be done with a PSA?
Free:total PSA ratio, if low then more likely to be prostate cancer, also PSA density (serum PSA/prostate volume) higher will mean more likely cancer
Why is prostate screening not offered?
Over diagnosis and over treatment is a concern
What is the current standard method for diagnosing prostate cancer?
Transperineal biopsy and transracial ultrasound guided biopsy
What is a transperineal biopsy?
Sampling prostatic tissue transperineally in a systematic manner, usually under general anaesthetic, allows better access to the anterior part of the prostate and had a lower risk of infection
What is a transracial ultrasound guided biopsy?
(TRUS) sampling transrectally, under local anaethetic, 12 cores are taken bilaterally in equal distribution from base to apex, 1-2% chance of sepsis
When should repeat biopsies be done?
after negative biopsy but still rising or persistent elevated PSA, if have small acinar proliferation or three sites of High grade prostatic intraepithelial neoplasia or atypical glands
What is the gleason grading system?
Scoring system by which prostate cancers are graded based on their histological appearance, assigned a score based on most common and second most common growth pattern, lowest= 3+3, higher the score the worse prognosis
What imaging can be done for prostate cancer?
Multi-parametric magnetic resonance imaging as identify abnormal areas of the prostate which are then targeted for biopsy by MRI-ultrasound fusion, staging by abdomen-peliv CT imagine and a bone scan
What is the management for prostate cancer?
discussed at an MDT, depends on stage of disease
What is watchful waiting?
symptom guided approach where definitive therapy is deferred and hormonal therapy is initiated at time of symptoms, used for older patients with lower life expectancy
What is active surveillance?
monitor patient every 3 months PSA, DREs every 6months- year and re biopsy 1-3 years assessing progression and intervening at an appropriate time
What is the surgical management for prostate cancer?
Radical prostatectomy- removal of prostate and resection of the seminal vesicles and surrounding tissue with possible dissection of the pelvic lymph nodes, erectile dysfunction, stress incontinence and bladder neck stenosis are common side effects
What other treatment is there for prostate cancer?
Radiotherapy and brachytherapy, chemotherapy and anti-androgen therapy (LHRH agonists, GnRH receptor agonists)
