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Surgery: Urology > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

Is it the most common cancer in men in the UK?

A

Yes

And it is the second most common cause of death due to cancer in men after lung cancer

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2
Q

What risk factors are there?

A 
Increasing age 
Obesity 
Afro-Caribbean ethnicity 
FH - 5 to 10% have strong FH 
Increased testosterone level 
Genetic predisposition (BRCA1 or 2)

Other less sig modifiable risks: obesity, DM, smoking, degree of exercise

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3
Q

95% are what type of cancer?

A

Adenocarcinoma

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4
Q

What area of the prostate is the cancer typically found?

A

Peripheral zone - 70%

Transitional zone - 20%
Central zone - 5%

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5
Q

In terms of symptoms, early cancer may be…

A

Asymptomatic

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6
Q

What symptoms are associated with localised disease?

A

Wide variety depending on stage
Localised disease - LUTS e.g weak stream, increased frequency, urgency, nocturia

More advanced localised disease: haematuria, haematospermia, incontinence, perineal or suprapubic pain, rectal pain and tenesmus

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7
Q

What symptoms suggest metastatic spread?

A 
Weight loss
Bone pain especially back and pelvis 
Lethargy 
Lymphadenopathy 
Spinal cord compression
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8
Q

What examination should be done?

A

DRE - feels rough, hard and nodular, asymmetrical

Normal prostate: walnut sized, smooth with palpable central sulcus

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9
Q

What differentials are there?

A

BPH
Prostatitis
Other causes of haematuria: bladder cancer, stones, UTI, pyelonephritis

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10
Q

What can cause a raised PSA?

A 
Prostate cancer 
BPH
UTI
Retention 
Prostatitis 
Vigorous exercise and recent ejaculation
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11
Q

Is it possible to have a normal PSA and still have prostate cancer?

A

Yes

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12
Q

What age related reference ranges are there for the PSA test?

A

Less than 49 < 2.5ng/ml
50-59 <3.5ng/ml
60-69 <4.5ng/ml
More than 70 <6.5

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13
Q

How can comparing free and bound PSA help with diagnosis?

A

Prostate cancer produces more bound PSA ie low free:total PSA

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14
Q

What investigations are there?

A 
DRE
PSA
Biopsy - template biopsy or transrectal US guided (TRUS) with biopsy 
Imaging - multi parametric MRI 
CTAP and bone scan for staging
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15
Q

Why is a TRUS useful?

A

Estimate size of prostate
Help stage any tumour present - generally 12 cores taken in equal distribution
Can examine upper renal tract for signs of dilation

Classical findings = hypodechoic area in peripheral prostate

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16
Q

What imaging shows bone mets?

A

X-ray - osteosclerotic lesions

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17
Q

What is the benefit of a template biopsy?

A

Lower infection risk

18
Q

Why is multi parametric MRI useful?

A

Identify abnormal areas of prostate, which can be targeted for biopsy

19
Q

Why has mp- MRI not replaced biopsy for the diagnosis of prostate cancer?

A

A subset of patients with prostate cancer will have neg MRI

20
Q

What system is used to grade prostate cancer?

A

The Gleason grading system - based on histological appearance

21
Q

When should PSA and DRE be considered?

A

Any LUTS
Erectile dysfunction
Visible haematuria

22
Q

Where is spread most often to?

A 
Bones - axial skeleton 
Lymph nodes - internal iliac, obturator, presacral 
Bladder
Rectum 
Seminal vesicles
23
Q

What system is often used for staging?

A

TNM

24
Q

Prostate cancers are often heterogeneous. What does this mean?

A

They show multiple different types of abnormal cell growth

25
Q

How is the Gleason score calculated?

A

Sum of the most common growth pattern plus second most common growth pattern

There are 5 grades of tissue
Lowest possible score is 2 and highest is 10

26
Q

What is the lowest score that can be assigned to someone with prostate cancer?

A

3+3

27
Q

Are high Gleason scores associated with better or worse prognosis?

A

Worse

28
Q

What is used to determine prognosis and recurrence risk?

A

Gleason score
PSA
TNM staging

29
Q

Is PSA produced by normal cells?

A

Yes

30
Q

Does the UK have a screening programme?

A

No - risk of over diagnosis and over treatment

31
Q

What advice should be given to asymptomatic men asking for PSA?

A

The test can be raised for other causes
Find cancers that may never cause any harm - most men that have prostate cancer die from unrelated cause
May have treatment for a cancer that may have never impinged on health
If false positive may have unnecessary tests done
Risks associated with treatment

32
Q

What factors suggest low level risk?

A

All of following:
PSA less than 10
Gleason less than or equal to 6
Clinical stage T1-T2a

33
Q

What suggests intermediate risk?

A

One of following:
PSA 10-20
Gleason 7
Clinical stage T2b

34
Q

What suggests high risk?

A

One of following:
PSA > 20
Gleason 8-10
Stage more than or equal to T2c

High risk cancer might grow or spread within a few years

35
Q

What does T3 mean?

A

Cancer has broken through the capsule
T3a - broken through capsule
T3b - cancer spread into seminal vesicles

36
Q

What does T4 mean?

A

Cancer spread into other body organs nearby e.g bladder or pelvic wall

37
Q

What does M1a, M1b and M1c mean?

A 
M1a = cancer cells in nodes outside pelvis 
M1b = cancer cells in bone
M1c= other parts of body
38
Q

What is T2a,b and c?

A 
T2a = cancer in only half of one side of prostate 
T2b = cancer in more than one half of one side, but not both sides 
T2c = cancer in both sides, but still within gland
39
Q

What does N1 mean?

A

Cancer cells in lymph nodes near prostate

40
Q

What is now the first line investigation for people with suspected clinically localised prostate cancer?

A

Multi parametric MRI

41
Q

Multi parametric MRI scan results are reported using what scale?

A

Likert scale

If > = 3 a multi parametric MRI influence biopsy offered

42
Q

What percentage of testosterone is derived from the testes?

A

95%

Surgery: Urology (2 decks)

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