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Year 4 Cancer Care and Haem > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

Prostate Cancer is an androgen dependent cancer, give 5 risk factors

A

Age
Family History
Genetics (BRCA2)
Race (African American)
High Pesticide exposure

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2
Q

Describe the typical histology of Prostate Cancer

A

95% Adenocarcinoma
75% in Peripheral Zone

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3
Q

Describe a low histological grade of Prostate Cancer (i.e Gleason 6)

A

Small and slow growing, typically confined to Prostate

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4
Q

Describe a high histological grade of Prostate Cancer (i.e Gleason 8-10)

A

Grow faster, invade through prostate capsule and infiltrate adjacent organs
Can disseminate

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5
Q

Describe the PSA level cut offs for biopsy

A

40-50y - 2.5
50-60y - 3.5
60-70y - 4.5
>70y - 6.5

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6
Q

Give four reasons against a nationalised Prostate Screening programme

A

-75% raised PSA is not cancer
-15% cancer does not have raised PSA
-Unable to distinguish between active and slow growing
- May over treat a slow growing prostate cancer that never would’ve become symptomatic

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7
Q

Give two reasons for a Prostate 2ww referral

A

Malignant feeling of Prostate OE
PSA> limit

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8
Q

How can a suspected Prostate Cancer be investigated?

A

-Bloods
-Urine Dip
-MRI - if staged at more than 3 on MRI scoring, then biopsy

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9
Q

The International Prostate Symptom Score rates prostatic symptoms from 0 to 5. State 5 of the parameters

A

Incomplete emptying
Frequency
Intermittency
Urgency
Weak Stream

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10
Q

Describe the typical presentation of localised Prostatic cancer

A

50% asymptomatic with elevated PSA

Weak stream, hesitancy, frequency, urgency

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11
Q

Describe the typical presentation of locally invasive Prostatic cancer

A

Haematuria
Haematosermia
Perineal pain
Impotence

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12
Q

Describe the typical presentation of metastatic Prostatic cancer

A

Bone pain/sciatica
Paraplegia
LN enlargement

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13
Q

Describe how a suspicious prostate would feel on DRE

A

Hard and irregular
Asymmetry
Nodule within one lobe
Adhesion to surrounding tissue

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14
Q

What staging is used for Prostate Cancer?

A

TNM

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15
Q

Gleason Grading is the best prognostic indicator for Prostate Cancer. What is it?

A

Two most common times of glandular growth patterns from biopsy are graded (can be heterogenous in which case it is just double)

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16
Q

Describe the histological score 1

A

Small uniform glands with minimal nuclear changes

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17
Q

Describe the histological score 2

A

Medium acinii separated by stromal tissue

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18
Q

Describe the histological score 3

A

Marked variation in glandular size and organisation

Infiltration of stroma by neighbouring tissues

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19
Q

Describe the histological score 4

A

Atypical cytology with extensive infiltration

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20
Q

Describe the histological score 5

A

Sheets of undifferentiated cells

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21
Q

What does a total Gleason score of less than 4 mean?

A

Well differentiated
10y risk of progression is 25%

22
Q

What does a total Gleason score of 5-7 mean?

A

Moderately differentiated
10y risk is 50%

23
Q

What does a total Gleason score of more than 7 mean?

A

Poorly differentiated
10y risk is 75%

24
Q

How do Gleason scores convert to a risk?

A

Low risk is 6 or less
Intermediate risk is 7
High risk is 8-10

25
Q

What is the NICE guidelines for management of low risk prostate cancer?

A

Offered the choice between active surveillance, radical prostatectomy and radical radiotherapy

26
Q

What is the NICE guidelines for management of intermediate/high risk prostate cancer?

A

Should be offered non surgical radical management (eg radiotherapy and androgen deprivation)

27
Q

Watchful waiting is a management option in non metastatic Prostate Cancer. What is it?

A

Continually monitored by GP

Any management will be focussed on symptom control rather than curative

28
Q

Active Surveillance is a management option in non metastatic Prostate Cancer. What is it?

A

Regular monitoring of patients who might benefit from full curative treatment in the future

Eg if they had a life expectancy of less than 10 years anyway, treatment may be delayed to preserve QoL

29
Q

What are the key differences between Watchful Waiting and Active Surveillance?

A

Active Surveillance requires more hospital based tests (WW is monitored by GP) and at any point treatment aims to cure

30
Q

What is a radical prostatectomy?

A

Removal of prostate gland, resection of seminal vesicles and surrounding tissue to get margin, and bilateral pelvic lymph node dissection
Laproscopic preferred

31
Q

There are two types of Radical Radiotherapy for Prostate Cancer (that work just as well as Prostatectomy). Describe External Beam Therapy

A

CT planned - conformational therapy
Normally after 3-6m of anti-androgen therapy

OR

Can do immune modulated radiotherapy, where different strength radiation beams are targeted to limit healthy tissue damage.

Can cause radiation cystitis/proctitis/impotence

32
Q

There are two types of Radical Radiotherapy for Prostate Cancer (that work just as well as Prostatectomy). Describe Brachytherapy

A

Transperineal implantation of radioactive seeds into the prostate
Contraindicated if previous TURP/prostate volume extremes

33
Q

Anti Androgen therapy is first line for metastatic disease alongside bilateral orchidectomy (but can be adjuvant/neoadjuvant/stand alone). What are LHRH analogues?

A

Eg Goserelin

Initial stimulation of pathway leads to eventual downregulation

Cause an initial flare of testosterone for around 10 days (so requires cover with an anti androgen)

34
Q

Name an Anti-Androgen

A

Flutamide

35
Q

Name an LHRH antagonist

A

Degarelix

36
Q

What are the two methods of Anti-Androgen therapy?

A

Continuous (can cause quicker progression to androgen independent state)
Intermittent (stopped and started depending on PSA)

37
Q

Give two short term and two long term complications of androgen therapy

A

Short term: Impotence, Loss of Libido

Long term: Muscle wasting, Osteoporosis

38
Q

Describe the use of radiotherapy in metastatic prostate disease

A

Normally to alleviate painful bones or spinal cord compression

39
Q

What would be the non hormonal chemotherapy agent of choice in Prostate cancer?

A

Docetaxel

40
Q

What should be done before a prostate biopsy to ensure it’s justified?

A

Multi parametric MRI

41
Q

Give a complication of Trans-Rectal Biopsy and how it is avoided

A

Prostatitis (may go on to gram neg sepsis)

Given IV antibiotic cover throughout procedure

42
Q

Give two complication of Transperineal Biopsy

A

Pain
Urinary Retention
Haematuria

Patients are asked to wait to leave after their biopsy until they’ve successfully passed urine

43
Q

What are the two different method of Prostatectomy?

A

Laproscopic
Open

44
Q

Give two advantages and a disadvantage of Laproscopic Prostatectomys

A

Advantages - small incisions only, quicker operation time

Disadvantages - Can cause post op Ileus due to air insufflation

45
Q

What are the two surgical angle approaches for Prostatectomy?

A

Transperineal

Retro Pubic

46
Q

What are three parameters for low risk prostate cancer?

A

PSA<10
Gleason<6
TNM- 1-2a

47
Q

What are the three parameters for intermediate risk prostate cancer?

A

PSA 10-20, Gleason 7, TNM 2b

48
Q

What are the parameters for high risk prostate cancer?

A

PSA>20
TNM >2c
Gleason 8-10

49
Q

What are the treatment options for low risk

A

Active Surveillance or Watchful waiting

Or radical therapy

50
Q

What are the treatment options for intermediate risk?

A

Radical therapy
Typically 3-6m anti-androgen therapy

51
Q

What are the treatment options for high risk prostate cancer?

A

Mainly anti-androgen therapy

Year 4 Cancer Care and Haem (16 decks)

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