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Metabolic - Urology > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

What are the risk factors for prostate cancer?

A
  • >50 - Black - Family hx - High levels of dietary fat - North American or northwest European
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2
Q

What genes are associated with prostate cancer?

A

Homebox gene HOXB13 = predisposition gene

BRCA 1 & 2

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3
Q

What % of 80 year old men have histological signs of prostate cancer?

A

80%

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4
Q

What is the lifetime risk of prostate cancer?

A

1 in 6

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5
Q

Where in the prostate do cancers most commonly develop?

A
  • 75% occur in the peripheral zone
  • 20% in the transitional zone
  • 5% in the central zone
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6
Q

What is the most likely histological precursor of prostate cancer?

A

High grade intra-epithelial neoplasia (PIN)

Characterised by cellular proliferation within pre-existing ducts and glands with cytological changes indicating neoplasm

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7
Q

Discuss clinical staging of prostate tumours

A

Tx: primary tumour cannot be assessed

T0: no evidence of primary tumour

T1: clinically inapparent tumour, not palpable (only found after histology)

T2: tumour palpable and within prostate

T3: extra-prostatic tumour that is not fixed or does not invade adjacent structures e.g. seminal vesicle(s)

T4: tumour is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum, bladder, levator muscles and or pelvic wall

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8
Q

Discuss pathological staging of prostate cancer

A

T2: organ confined

T3: extraprostatic extension

T4: invades structures other than seminal vesicles

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9
Q

What is the function of the prostate gland?

A
  • Exocrine gland
  • Secretes prostatic fluid which is alkaline and helps neutralise vaginal acidity
  • Comprises 30% of the ejactulate
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10
Q

What is PSA?

A

Prostate specific antigen

  • A protease that functions to make the semen more liquid
  • Produced by the epithelial prostatic cells and secreted into the seminal fluid where it is involved in liquefaction of the seminal coagulum
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11
Q

Discuss the causes of a raised PSA

A
  • Prostate cancer
  • BPH
  • Prostatitis
  • UTI

Prostate injury

  • Surgery
  • Ejaculation
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12
Q

What is a normal PSA level?

A

>4.0 ng/mL

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13
Q

What should the PSA be in men under 50?

A

<2.5ng/mL

A PSA of >10ng/mL will show cancer in 50%

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14
Q

Discuss risk levels for prostate cancer

A

Low risk: T2a, Gleason 6, PSA <10

Medium risk: T2b, Gleason 7, PSA 10-20

High risk: T3a+, Gleason 8, PSA >20

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15
Q

Discuss ISUP grading

A

Grade 1 - Gleason score of 6 or less

Grade 2 - Gleason score of 7 (3+4)

Grade 3 - Gleason score of 7 (4+3)

Grade 4 - Gleason score of 8

Grade 5 - Gleason score of 9-10

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16
Q

Discuss Gleason’s pattern scale

A

Obtained by analysing the histology from two separate areas of tumour and adding the scores together

17
Q

Discuss free PSA

A

A free PSA >10% suggests the presence of agressive cancer

18
Q

Discuss the diagnostic approach for prostate cancer

A
  • DRE
  • PSA test
  • If PSA above their age-specific reference range, urgent 2 week cancer referral
  • Guidelines recommend a biopsy for men with a PSA >3ng/L
  • Biopsy: 10-12 cores
19
Q

Discuss the link between testosterone and prostate cancer

A
  • Men with lower testosterone levels are less likely to develop prostate cancer than those with high levels
20
Q

What are the 1st order investigations for prostate cancer?

A
  1. PSA
  2. Testosterone
  3. LFTs
  4. FBC
  5. Renal function
  6. Biopsy
21
Q

What should be done if a prostate biopsy is negative despite a raised PSA?

A

Close follow up with DRE and repeat PSA within 6-12 months of the biopsy

22
Q

Discuss treatment of low risk prostate cancer

A

Low risk: surveillance (Gleason score of 6 or less), xRT, prostatectomy, androgen deprivation therapy

xRT is preferred by older men

23
Q

Discuss androgen deprivation in prostate cancer

A

Removal of testosterone blocks that growth of prostate caner but doesn’t cure it

a) GnRH agonists: goserelin and leuprorelin are orchidectomy are equally affective at lowering circulating androgens

*GnRH androgens cause a rise in LH and testosterone during the first week of use and can cause worsening of metastatic disease and must be combine with an anti-androgen such as flutamide

b) Androgen receptor blockers: biclutamide and enzalutamide
c) Androgen synthesis inhibitors: abiraterone which functions by inhibiting CYP17
d) Corticosteroids and oestrogens: useful in disease that has become refractory to castration

24
Q

Where does prostate cancer most commonly metastasise to?

A

Bones

Lungs, LNs, Liver and brain

25
Q

Discuss signs of prostate cancer remote to the prostate

A
  • Back pain, hips, thighs and other bones
  • Oedema
  • Weight loss
  • Fatigue
  • Change in bowel habits
  • Haematuria
  • Decline in renal function
26
Q

What is the half life of PSA?

A

2.2-2.3 days

Declines to original value after 4-8 weeks

27
Q

What is bicalutamide?

A

Non-steroidal anti-androgen

  • Androgen receptor blocker, prevents the binding of adrenal and testicular androgens and thus inhibits prostatic growth
28
Q

What is goserelin?

A

Potent inhibitor of pituitary gonadotropin secretion

29
Q

What is flutamide?

A

Blocks the action of both endogenous and exogenous testosterone by binding to the androgen receptor

Capable of inhibiting prostatic nuclear uptake of androgen

30
Q

What are the side effects of androgen suppression therapy?

A
  • Hot flushes
  • Loss of libido
  • Weight gain
  • Metabolic syndrome
  • Loss of bone density
  • CV side effects
  • Cogitive decline
  • Difficulty controlling blood glucose
31
Q

What advice can be given to asymptomatic men asking for a PSA blood test?

A
  • The test is not very accurate and we cannot say that those having the test will live longer - even if they do have prostate cancer
  • Most men with prostate cancer die from an unrelated cause
  • If the test is falsely positive they will need further testing e.g. prostate sampling which can cause bleeding and infection
  • Only 1/3 of people with a raised PSA will have prostate cancer
  • If cancer is found and treatment begun, the treatment may cause more harm than the cancer
  • Ultimately the decision is the patient’s
32
Q

How can metastatic prostatic cancer be treated?

A
  • Orchidectomy, most men refuse

Metabolic - Urology (10 decks)

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