Prostate Cancer Flashcards
Is it the most common cancer in men in the UK?
Yes
And it is the second most common cause of death due to cancer in men after lung cancer
What risk factors are there?
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
95% are what type of cancer?
Adenocarcinoma
What area of the prostate is the cancer typically found?
Peripheral zone - 70%
Transitional zone - 20%
Central zone - 5%
In terms of symptoms, early cancer may be…
Asymptomatic
What symptoms are associated with localised disease?
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
What symptoms suggest metastatic spread?
Weight loss Bone pain especially back and pelvis Lethargy Lymphadenopathy Spinal cord compression
What examination should be done?
DRE - feels rough, hard and nodular, asymmetrical
Normal prostate: walnut sized, smooth with palpable central sulcus
What differentials are there?
BPH
Prostatitis
Other causes of haematuria: bladder cancer, stones, UTI, pyelonephritis
What can cause a raised PSA?
Prostate cancer BPH UTI Retention Prostatitis Vigorous exercise and recent ejaculation
Is it possible to have a normal PSA and still have prostate cancer?
Yes
What age related reference ranges are there for the PSA test?
Less than 49 < 2.5ng/ml
50-59 <3.5ng/ml
60-69 <4.5ng/ml
More than 70 <6.5
How can comparing free and bound PSA help with diagnosis?
Prostate cancer produces more bound PSA ie low free:total PSA
What investigations are there?
DRE PSA Biopsy - template biopsy or transrectal US guided (TRUS) with biopsy Imaging - multi parametric MRI CTAP and bone scan for staging
Why is a TRUS useful?
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
What imaging shows bone mets?
X-ray - osteosclerotic lesions
What is the benefit of a template biopsy?
Lower infection risk
Why is multi parametric MRI useful?
Identify abnormal areas of prostate, which can be targeted for biopsy
Why has mp- MRI not replaced biopsy for the diagnosis of prostate cancer?
A subset of patients with prostate cancer will have neg MRI
What system is used to grade prostate cancer?
The Gleason grading system - based on histological appearance
When should PSA and DRE be considered?
Any LUTS
Erectile dysfunction
Visible haematuria
Where is spread most often to?
Bones - axial skeleton Lymph nodes - internal iliac, obturator, presacral Bladder Rectum Seminal vesicles
What system is often used for staging?
TNM
Prostate cancers are often heterogeneous. What does this mean?
They show multiple different types of abnormal cell growth
