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Cancer Care > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

What is the most common cancer in men?

A

Prostate

second most common cause of cancer deaths in men

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2
Q

What are the risk factors for prostate cancer?

A 
Age >50 
African origin 
Family history 
Genetics (BRCA 1 & BRCA 2)
Obesity
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3
Q

In which area of the prostate do prostate cancers most commonly arise?

A

Peripheral zone (75%)

transitional zone (20%)
central zone (5%)
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4
Q

What are the two most common types of prostate cancer?

A

95% of prostate cancer = adenocarcinoma

Acinar adenocarcinoma
Ductal adenocarcinoma

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5
Q

What are the red flag symptoms for prostate cancer?

A 
LUTS
Back pain/bone pain 
Weight loss
Erectile dysfunction 
Haematuria 
Lethargy
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6
Q

What are the Lower Urinary Tract Symptoms?

A 
urgency
frequency
terminal dribbling 
hesitancy 
nocturia 
overactive bladder
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7
Q

What is Prostate Specific Antigen?

A

PSA = a protein produced by prostate epithelial cells to liquefy semen.
Small amounts of PSA leak into the blood, if there is altered architecture in the prostate then more will be released into the blood.

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8
Q

What are the possible causes of a raised PSA?

A 
PROSTATE CANCER
BPH 
Prostatitis
Acute urinary retention 
TURP
Urinary catheterisation 
Recent DRE
Recent ejaculation 
Vigorous exercise
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9
Q

What are the criteria for a 2WW referral?

A

Abnormal DRE
PSA >3 in men aged 50-69
Red flag symptoms

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10
Q

How is PSA density calculated?

A

Total PSA/prostate volume

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11
Q

How might prostate cancer feel on a DRE?

A

Hard, irregular/craggy, lack of mobility, loss of central sulcus, may have a nodule in one lobe, induration, asymmetry of the gland.

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12
Q

What further investigations would you perform if suspecting prostate cancer?

A

Multiparametric MRI prostate
Transrectal ultrasound + biopsy or Transperianal biopsy
Radioisotope bone scan
CT CAP

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13
Q

Other than adenocarcinoma, what other types of cancer can form in the prostate?

A

Transitional Cell Carcinoma
Neuroendocrine (e.g. small cell carcinoma)

these are rare

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14
Q

What system is used to assess the histological grade of prostate cancers?

A

Gleason Score

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15
Q

What Gleason scores indicate low, intermediate and high grade adenocarcinomas?

A

Low: Gleason = 6
Intermediate: 7
High: 8-10

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16
Q

Which structures are at risk of direct invasion from prostate cancer?

A

Seminal vesicles
Bladder
Rectum

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17
Q

What organs does prostate cancer commonly metastasise to?

A

Bone
Regional lymph nodes
Lung
Liver

18
Q

What staging system is used in prostate cancer?

19
Q

What questionnaire can be used to ask about symptoms of prostate cancer?

A

International Prognostic Scoring System (IPSS)

20
Q

Which patients will require an isotope bone scan as part of their investigations?

A

Patients with:

  • T3-4 tumours
  • Gleason 8-10
  • PSA > 15 micrograms/L
  • symptoms/signs/biochemical evidence of bone mets
21
Q

How might locally advanced prostate cancer present?

A

Impotence (due to neurovascular bundle infiltration)
Haemospermia
Ureteric obstruction and kidney failure
Rectal symptoms e.g. tenesmus, rectal bleeding
Lymph node spread, with lymphoedema in the legs and genitals

22
Q

Is metastatic prostate cancer cureable?

23
Q

Why does castration work as a treatment option for prostate cancer?

A

Prostate cancer is androgen dependent. Castration decreases androgen levels, therefore inhibiting cancer growth.

24
Q

What are the management options for low risk prostate cancers?

A

Watch and wait (when there is no intention to do curative treatment)
Active surveillance (when curative treatment is intended should the cancer progress)
Radical prostatectomy
Radical radiotherapy

25
Q

What are the management options for intermediate risk prostate cancers?

A

Active surveillance
Radical prostatectomy OR raditherapy + 6 months androgen deprivation therapy
+/- Brachytherapy

26
Q

What are the management options for high risk prostate cancer?

A

Radical prostatectomy or radical radiotherapy
Androgen deprivation therapy for 3 years
+/- Brachytherapy

27
Q

What does radical prostatectomy involve?

A

Removal of the entire prostate gland, seminal vesicles and surrounding tissue.
Can be open, laparoscopic or robot assisted

28
Q

What are the potential risks involved with radical prostatectomy?

A

Urinary incontinence
Erectile dysfunction
Bladder neck stenosis
Incomplete tumour resection (20% recurrence rate)

29
Q

What are the potential risks involved with external beam radiotherapy for prostate cancer?

A

Bowel problems
Erectile dysfunction
Incontinence
Slightly increased risk of colorectal cancer

30
Q

What is bracytherapy?

A

Implantation of a radioactive source into the prostate to kill cancer cells.

Low dose = permanent implantation of radioactive seeds
High dose = temporary insertion of radioactive source through a fine catheter

31
Q

Outline the hormonal treatment options available in prostate cancer.

A
  1. Castration - surgical or medical

2. Androgen blockade (block androgen receptors on cancer cells)

32
Q

What are the two types of castration?

A
  1. Surgical = bilateral orchidectomy
    - achieves permanent reduction in circulating androgens
    - side effects = impotence, loss of libido, mood disturbance, muscle weakness, osteoporosis
  2. Medical castration with LHRH agonists e.g. GOSERELIN
    - given as depot s/c injection
    - causes an initial flare in disease due to rise in testosterone, followed by fall to castration level as negative feedback suppresses the anterior pituitary
    - side effects = same as with surgical castration + flushing, sweats, weight gain
    - IS REVERSIBLE, but may take many months to recover
33
Q

What additional requirement will patients taking goserelin (LHRH agonist) need?

A

Will require anti-androgen cover for the first 2 weeks of treatment with LHRH agonist to avoid disease flare.

E.g. Bicalutamide, flutamide, cyproterone acetate

34
Q

What drugs are used in an androgen blockade?

A

Non-steroidal anti-androgens: BICALUTAMIDE or FLUTAMIDE

  • anti cancer effects are less but can preserve libido/potency because causes incomplete anrogen blockade
  • may cause gynaecomastia

Steroidal anti-androgens: CYPROTERONE ACETATE
- not recommended for long term use due to toxicities (VTE, hepatotoxicity)

35
Q

What is meant by the term maximal androgen blockade?

A

Surgical or medical castration + androgen blockade

36
Q

What the potential uses of palliative radiotherpay?

A

Palliative EBRT can be used to alleviate the symptoms of metastatic cancer:

  • painful bone mets
  • spinal cord or nerve root compression
  • symptomatic soft tissue disease

Radioactive strontium, given as a single IV injection, can effectively irradiate multiple bone mets, giving pain relief and therefore delaying the need for further analgesia and radiotherapy

37
Q

What factors must be taken into consideration when deciding on a patient’s treatment plan?

A
  1. The life expectancy of the patient, taking into account age and co-morbidities
  2. The predicted natural history of the cancer, determined by stage, Gleason score and PSA
  3. The patient’s preferences, with consideration of the likely toxicities of treatment
38
Q

When is androgen deprivation therapy used on its own?

A

Used to treat localised prostate cancer in patients who are unfit for radical surgery or radiotherapy. However, this treatment only has a temporary impact, and hormone-refractory disease will eventually develop.

39
Q

What is the average duration of response to hormone therapy in metastatic prostate cancer?

A

18-24 months

40
Q

Give an example of an LHRH antagonist.

Cancer Care (5 decks)

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