Prostate cancer Flashcards
Describe the pathophysiology of prostate cancer?
- Growth of the cancer is influenced by androgens
- Majoiry are adenocarcinomas
- Arise from peripheral zone (75%), transitional zone (20%) and central zone (5%)
- They can often be multifocal
What are the different types of prostate adenocarcinomas?
- Acinar adenocarcinomas
- Ductal adenocarcinomas
Describe Acinar prostate adenocarcinomas?
- Originate in the glandular cells of the prostate
- Most common form
Describe Ductal prostate adenocarcinomas?
- Originates in the cells that line the ducts of the prostate glands
- Tend to grow and metastasise faster than acinar
What are the main risk factors for developing prostate cancer?
- Age
- Ethnicity
- African or Caribbean are twice as likely than Caucasians
- Family history of prostate cancer
- Genetic predisposition
- Increased risk in those with BRCA2 or BRCA1 gene
- Less significant modifiable risk factors:
- DM, smoking, obesity
What are the clinical features of prostate cancer?
- Localised disease:
- LUTS including weak stream, frequency and urgency
- Advanced disease:
- haematuria, dysuria, incontinence, haematospermia
- bone pain, anorexia, weight loss
What is essential if a diagnosis of prostate cancer is suspected?
- Digital rectal examination (DRE)
- Most arise from posterior peripheral zone
- Asymmetry, nodularity, fixed irregular mass
- Tumours >0.2mL can be palpable
Name some differentials for prostate cancer?
- Benign prostatic hyperplasia (BPH)
- Non-cancerous enlargement of prostate
- LUTS symptoms initially
- Prostatitis
- Inflammation of prostate
- Perineal pain with neutrophils on urinalysis
- OTher causes of haematuria
Describe the invesitgations that should be carried out if. a diagnosis of prostate cancer is suspected?
- PSA
- Multiparametric is first line investigation if prostate cancer is suspected
- Biopsies of prostatic tissue:
- Transperineal (template) biopsy
- Transrectal ultrasound-guided (TRUS) biopsy
- Repeat prostate biopsy
What can cause the PSA to be artificially raised?
- BPH
- Prostatitis
- Exercise
- Ejaculation
- Recent DRE
Describe the age ranges and their corresponding normal PSA?
What further investigations can be performed with a person’s PSA?
- Free:total PSA ratio
- Low is associated with increased chance of developing prostate cancer
- PSA density
- PSA is divided by prostate volume determined by imaging
- Higher PSA densities indicate increased chance of prostate cancer
Describe Prostate cancer screening?
No national prostate cancer screening programme
Describe Transperineal (template) biopsy?
- Invovles sampling prostatic tissue transperineally in a systemic manner
- Done as a day case under general anaesthetic
- Allows better access to anterior prostate with a lower infection risk
Describe a TRUS biopsy?
- Invovles sampling the prostate transrectally under LA
- 12 cores are taken bilaterally from base to apex
- 1-2% risk of sepsis
How are prostate cancers graded
- Gleason grading system
- Based on histological differentiation
- Sum of most common growth pattern + second most common growth pattern seen
How are localised prostate cancer managed?
- Management is based on risk stratification involving:
- PSA levels
- Gleason score
- T staging (from TNM)
