Prostate cancer Flashcards
1
Q
What is prostate cancer?
A
- Walnut sized gland in the male pelvis
- Located inferior to the bladder and anterior to the rectum
- Urethra runs through the centre of the prostate
- Role in bladder control and male reproductive system
- Cancer occurs when there is uncontrolled growth of glandular cells in the prostate
- 99% of all prostate cancers are adenocarcinomas
- Rarely can be sarcomas, TCC, SCC and neuroendocrine
- Often slow growing but can be more aggressive
- Most commonly found in the posterior peripheral portion (70%)
- Not to be confused with benign prostatic hyperplasia
2
Q
Clinical signs and symptoms of prostate cancer
A
- Usually shows no symptoms until cancer is large enough to put pressure on urethra
- Frequent or sudden need to urinate
- Difficult to urinate (for example, trouble starting or not being able to urinate when the feeling is there or poor urine flow)
- Discomfort when urinating
- Blood in urine or semen
- Pain in the lower back, upper thighs or hips
- Many diseases can cause these symptoms
3
Q
Alternative tests for prostate cancer
A
- Early detection is important for successful outcome
- Screening tests valuable in early detection
- Physical examination and medical history
- Rectal examination feeling for hard and bumpy gland
- Referred to as digital rectal exam (DRE)
- Blood test to check for prostate-specific antigen (PSA), a protein produced by the prostate.
- The level of PSA can be higher than normal in people with prostate cancer (but also in people with other prostate conditions that are not cancer)
- Biopsy
- Medical Imaging tests
4
Q
Medical imaging tests for prostate cancer
A
- Wide range of modalities used in the diagnosis and staging of prostate cancer
- CT, MRI, U/S and NM can all play a role in diagnosis and staging
- Screening tool to assess need for more invasive investigation or rule out other causes
- Helps in staging of the cancer
- Determines extent and spread of cancer
- Presence of any metastases
- This guides treatment pathways to deliver an individualised treatment plan
5
Q
MRI for prostate cancer
A
- Increasing role in the confirmation of diagnosis
- Important modality in the staging of prostate cancer
- Increased contrast resolution allows for more accurate evaluation of localised spread and define boarders of the tumour
- Helps guide area for tumour biopsy
- Allows visualisation of extension into nearby tissues
- Identify spread to local lymph nodes
- Used in planning of radiation therapy
- Potentially helpful in identification of liver metastases
- Used in the evaluation of tumour recurrence
- Alternative modality to U/S for biopsy guidance
6
Q
Ultrasounds for prostate cancer
A
- Transrectal Ultrasound (TRUS) is often initially performed to detect abnormalities and to guide biopsy.
- Usually next step following an abnormal PSA level or DRE.
- Conventional ultrasound often used as a screening test to rule out other causes for raised PSA. (e.g. Benign prostatic hyperplasia)
- Potential use in evaluation biopsy of metastases (e.g. liver)
- TRUS preferred modality for placement of Brachytherapy seeds treatment therapy.
7
Q
CT for prostate cancer
A
• Standard CT Abdomen is insensitive to Prostate Cancer detection.
• Has the ability to identify other complicating abdominal pathologies.
• Commonly used in the staging of Prostate Cancer.
CT
• Sensitive test to common sites of metastatic spread. (bone, lung & liver)
• Used to check placement of brachytherapy seeds
8
Q
NM for prostate cancer
A
- Technetium bone scans preferred method of identifying bone mets
- Prostate cancer most commonly metastasises to bone
- Gallium Prostate Specific Membrane Antigen (PSMA) PET scans highly sensitive in the detection of prostate cancer cells.
- Used in the diagnosis, staging, restaging, recurrence, therapy response and patient prognosis
- Fluorine-18-fluciclovine PET is used to detect and localise suspected prostate cancer recurrence based on elevated prostate-specific antigen in men who have undergone prior treatment
9
Q
Prostate cancer staging
A
- Ascertain tumour size, location and spread
- Know extent of disease to plan the best treatment plan
- Diagnostic tests discussed help with assessment
- Prostate staged using the TNM system
- Tumour (T): Extent of primary tumour and where it has grown to.
- Node (N): Has the tumour spread to the local lymph nodes?
- Metastasis (M): Has the cancer metastasised to other parts of the body? If so, where and how much?
- In addition prostate cancer uses the Gleason score to grade group.
- This factors the aggressiveness of the tumour to aid prognosis and treatment pathway
10
Q
T. score
A
- Describes growth of primary tumour.
- Prostate cancer uses both a clinical and pathological T score.
- Clinical T Score
- T0: There is no evidence of primary tumour.
- T1: Clinically inapparent tumour that is not palpable.
- T2: Tumour is palpable but confined within the prostate.
- T3: Extraprostatic tumour that is not fixed or does not invade adjacent structures.
- T4: Tumour is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall.
- Pathological T Score
- T2: Organ confined.
- T3: Extraprostatic extension.
- T4: Tumour is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles, and/or pelvic wall.
11
Q
N. score
A
- The ‘N’ in the TNM system stands for lymph nodes. • Regional lymph node status.
- Lymph nodes of the pelvis, inferior to iliac bifurcation • NX: regional nodes were not assessed
- N0: no positive regional nodes
- N1: metastases in regional node(s)
- Regional node status is usually assessed via diagnostic imaging and biopsy
12
Q
M. score
A
- The ‘M’ in the TNM system describes cancer that has spread to other parts of the body.
- Common sites of spread for Prostate cancer Bone, Liver and lungs.
- M0: The disease has not spread to a distant part of the body.
- M1a: The cancer has spread to non regional lymph nodes
- M1b: The cancer has spread to the bone.
- M1c: The cancer has spread to other distant sites without bone involvement. (Lung, Liver, etc.)
13
Q
Gleason score
A
- Histological examination of biopsied tumour.
- Used to assess the aggressiveness of the tumour.
- Samples of the two largest areas of tumour are taken.
- Gleason Score ranges from 1-5 and describes how much the cancer from a biopsy looks like healthy tissue.
- Higher the score the more abnormal the tissue.
- Most cancers have a score of 3 or more.
- Scores of 6 or less grow slowly and have good prognosis.
- 7 is an intermediate risk of aggressive cancer
- 8-10 are high grade cancers that are likely to spread rapidly.
14
Q
Treatment for prostate cancer
A
- Treatment is tailored to individual circumstances.
- Type, stage and aggressiveness of cancer will dictate the most appropriate treatment method.
- Age and general patient health are also considered.
- Treatment approaches can be passive.
- Watchful waiting – Slow growing cancer usually in older men, monitor PSA and only act if required.
- Active surveillance — means regular PSA tests and repeat biopsies. Cancer closely monitored in younger men.
- Active.
- Surgery
- Radiotherapy
- Hormone therapy • Chemotherapy
15
Q
Surgery for prostate cancer
A
- Surgical removal of the prostate is called a radical prostatectomy.
- Can be performed as open or laparoscopically depending on size and location.
- Robotic assisted prostatectomy can now be performed.
- Performed when cancer is categorised as locally advanced.
- Surgery removes prostate, seminal vesicles and surrounding tissue
- Recovery time is generally around 6 weeks
- Complications include urinary incontinence, erectile dysfunction and lymph oedema.
- If the prostate can’t be removed, a transurethral resection of the prostate (TURP) to relieve urination problems
