Prostate Cancer Flashcards
What is the growth of the prostate influenced by
androgens (testosterone and dihydrotestosterone (DHT)).
The majority of prostate cancer is what type and in which zone of the prostate
adenocarcinomas and Over 75% of prostate adenocarcinomas arise from the peripheral zone
What are the two types of adenocarcinoma
Acinar - from glandular cells of the prostate
Ductal - from the cells that line the ducts of the prostate
what are the risk factors of prostate cancer
Age - men older than 75
Family history
Ethnicity - Afro Caribbean’s
Genetics - BRCA1/2 genes
DM
Smoking
what are the clinical features of prostate cancer
LUTS - Weak stream, increased frequency, urgency
More advanced - haematuria, bone pain, anorexia, weight loss
What can you feel on a DRE
asymmetry, nodularity, or a fixed irregular mass
what are the differential diagnosis
BPH
Prostatitis
Bladder cancer, urinary stones, UTI, pyelonephritis
What are the lab tests for prostate cancer
PSA
There are age thresholds for PSA as PSA naturally goes up with age
How can PSA become falsely elevated
BPH, prostatitis, vigorous exercise, ejaculation
How are biopsies of the prostate taken
TRUS - transrectal ultrasound guided biopsy
Transperineal biopsy
What is Involved in TRUS
12 cores are taken bilaterally in equal distribution from base to apex
What is the Gleason score
The Gleason grading system is a scoring system by which prostate cancers are graded, based upon their histological appearance.
how is the Gleason score calculated
Gleason Score is then calculated as the sum of the most common growth pattern + the second most common growth pattern seen.
What is mp-MRI
Used to aid the diagnosis of prostate cancer as it highlights the areas of abnormal cells - this is often done before biopsies
What imaging is used to stage prostate cancer
CT CAP
What is low risk prostate cancer
Gleason score of 6 or below
What is the treatment of low risk cancer
Active surveillance
What is the intermediate risk
Gleason score of 7
Treatment of intermediate
Active surveillance/ radical options can be discussed
What is high risk cancer
Gleason score of 8 and above
What is the treatment for high risk cancer
Radical prostatectomy
What is the treatment for metastatic disease
Chemotherapy and anti-hormonal agents
Anti-hormonal:
Bicalutamide (Testosterone receptor antagonist) for 28days
LHRH analogue injection ( eg - goserelin ) after 14 days – repeated every
month (3 month/6 month dose when stable)
Chemotherapy:
Docetaxel
what is the definition of castrate resistant prostate cancer
Prostate cancer that keeps growing even when the amount of testosterone in the body is reduced to very low levels
How do you treat castrate-resistant prostate cancer
Add bicalutamide back in
(Maximum Androgen Blockade) Dexamethasone Docetaxel chemotherapy
Abiraterone/Enzalutamide
Palliative Care
What is watchful waiting
Watchful waiting is a symptom-guided approach to prostate cancer management where definitive therapy is often deferred and hormonal therapy is initiated at time of symptomatic disease
Offered to older patients with lower life expectancy- aim is not to cure
what is active surveillance
Active surveillance can be offered to select patients with low-risk disease and for some cases of intermediate-risk disease. Active surveillance requires monitoring of patients with 3-monthly PSA, 6 month to yearly DRE, and re-biopsy at 1-3 yearly intervals assessing for progression and intervening at the appropriate time.
What is the surgical management for prostate cancer
Radical prostatectomy
removal of the prostate gland, resection of the seminal vesicles, along with the surrounding tissue +/- dissection of the pelvic lymph nodes.
what are the side effects of radical prostatectomy
erectile dysfunction
stress incontinence
bladder neck stenosis
what is brachytherapy
transperineal implantation of radioactive seeds (usually Iodine-125) directly into the prostate gland
What is external beam therapy
focused radiotherapy to target the prostate gland
