Prostate Cancer Flashcards
How is prostate cancer diagnosed?
Early prostate cancers have few symptoms
Metastatic disease may present as bone pain
Locally advanced disease may present as pelvic pain or with urinary symptoms
Prostate specific antigen measurement
DRE
Trans rectal USS (+/- biopsy)
MRI/CT and bone scan for staging
How is PSA testing used in the identification of prostate cancer?
Normal upper limit of PSA is 4ng/ml (some BPH and some cancer)
Percentage of free PSA: total PSA may help to distinguish between benign disease and cancer, (values <20% are suggestive of cancer)
What can cause false positives in PSA testing?
Prostatitis
UTI
BPH
Vigorous DRE
What is the pathology of prostate cancer?
95% adenocarcinoma
Often multifocal - 70% lie in the peripheral zone
What score is used to grade prostate cancer?
Gleason grading system
2 best, 10 worst
What lymph nodes are most commonly affected by prostate cancer?
Obturator nodes
Local extra prostatic spread to the seminal vesicles
What is the treatment of prostate cancer?
Watchful waiting - elderly, multiple co-morbidities, low Gleason score.
Active surveillance - deferred radical treatment.
Low risk men. Gleason score 3 + 3, at least 10 biopsy cores (cancer <50% and at least one re-biopsy)
If they show evidence of disease progression, offer radical treatment.
Radiotherapy (External) - Either curative or palliative, similar survival to surgery.
Surgery - Radical prostatectomy (removal of the prostate is tx of localised disease, obturator nodes can also be removed)
Hormone therapy - Most have a degree of testosterone dependence.
Either: bilateral orchidecomy, LHRH analogues and anti-androgens.
What are the complications of prostate radiotherapy?
Radiation proctitis
Rectal malignancy
What is a key complication of radical prostatectomy?
Erectile dysfunction
