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?

24
Q

Prostate cancers are often heterogeneous. What does this mean?

A

They show multiple different types of abnormal cell growth

25
How is the Gleason score calculated?
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
What is the lowest score that can be assigned to someone with prostate cancer?
3+3
27
Are high Gleason scores associated with better or worse prognosis?
Worse
28
What is used to determine prognosis and recurrence risk?
Gleason score PSA TNM staging
29
Is PSA produced by normal cells?
Yes
30
Does the UK have a screening programme?
No - risk of over diagnosis and over treatment
31
What advice should be given to asymptomatic men asking for PSA?
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
What factors suggest low level risk?
All of following: PSA less than 10 Gleason less than or equal to 6 Clinical stage T1-T2a
33
What suggests intermediate risk?
One of following: PSA 10-20 Gleason 7 Clinical stage T2b
34
What suggests high risk?
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
What does T3 mean?
Cancer has broken through the capsule T3a - broken through capsule T3b - cancer spread into seminal vesicles
36
What does T4 mean?
Cancer spread into other body organs nearby e.g bladder or pelvic wall
37
What does M1a, M1b and M1c mean?
``` M1a = cancer cells in nodes outside pelvis M1b = cancer cells in bone M1c= other parts of body ```
38
What is T2a,b and c?
``` 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
What does N1 mean?
Cancer cells in lymph nodes near prostate
40
What is now the first line investigation for people with suspected clinically localised prostate cancer?
Multi parametric MRI
41
Multi parametric MRI scan results are reported using what scale?
Likert scale | If > = 3 a multi parametric MRI influence biopsy offered
42
What percentage of testosterone is derived from the testes?
95%