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Prostate Cancer (AAG) Flashcards

1
Q

How common is prostate cancer in the UK, compared to other cancers?

A

It is the most common cancer in men

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2
Q

How many new cases of prostate cancer are there in the UK a year?

A

47,700

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3
Q

How many deaths from prostate cancer are there in the UK a year?

A

10,000

i’ve checked this, its right. seems like proportionally a lot but there ya go

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4
Q

What % of cases of prostate cancer occur in men over 70 years of age?

A

60%

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5
Q

What % of patients with prostate cancer have metastatic disease at presentation?

A

Nearly 50%

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6
Q

What % of patients with prostate cancer present with localised extracapsular spread?

A

25%

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7
Q

What has happened to the incidence of prostate cancer in recent years?

A

Substantial increases

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8
Q

What is causing the substantial increase in incidence of prostate cancer in recent years?

A

Some may be due to real increase in risk, but additionally the increased use of TURP and PSA testing may have increased the detection rate

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9
Q

How does the reported incidence of prostate cancer differ in the USA compared to UK?

A

Up to 10x higher

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10
Q

What is the high incidence of prostate cancer in the USA compared to UK likely due to?

A

Effect of widespread prostate cancer screening

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11
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma

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12
Q

What % of prostate cancers occur in the peripheral zone?

A

70%

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13
Q

What % of prostate cancers occur in the transitional zone?

A

20%

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14
Q

What % of prostate cancers occur in the central zone?

A

10%

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15
Q

In what % of prostate cancers is family history a feature?

A

10%

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16
Q

What might happen in patients with a family history of prostate cancer?

A

They might develop it at a younger age

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17
Q

What genes have been implicated in hereditary prostate cancer?

A
  • BRCA1 and BRCA2 mutations

- HPC1 and BPC2 mutations

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18
Q

What are the racial differences in the incidence of prostate cancer?

A

Black > Caucasian > Asian (East and Southeast Asia, e.g. China)

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19
Q

What is the role of diet in prostate cancer?

A

Controversial, but thought that high-fat, low-fibre, smoked foods and dairy produce may increase risk, whilst soya beans and retinoids appear to be protective

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20
Q

How does the incidence of prostate cancer in vegetarians compare to that of omnivores?

A

50-75%

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21
Q

How does prostate cancer that is confined to the prostate present?

A

Completely asymptomatic

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22
Q

How do patients with a large component of benign prostatic hyperplasia, but with transitional zone prostate cancer, often present?

A

Bladder outlet obstruction, but no signs of prostate cancer

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23
Q

How are patients with a large component of benign prostatic hyperplasia with transitional zone prostate cancer often diagnosed?

A

Via transurethral resection

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24
Q

What is the most frequent presentation of locally advanced prostate cancer?

A
  • Urinary frequency
  • Poor urine flow
  • Difficulty starting or stopping urination
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25
What general features may be present in advanced prostate cancer?
- Bone pain - Lethargy - Weight loss - Bilateral leg oedema
26
What causes bone pain in advanced prostate cancer?
Metastatic disease
27
What are the referral criteria for suspected asymptomatic prostate cancer?
Detection of raised PSA
28
What should be included in examination in a patient with prostate cancer?
- Rectal examination | - Surgery for focal bone tenderness
29
What routine blood tests are done in prostate cancer?
- Serum PSA - FBC - Acid and alkaline phosphatase - Serum biochemistry
30
What is PSA?
A serine protease that dissolves prostatic coagulum
31
What is the likelihood of a patient having prostate cancer with PSA levels between 4-10 ug/L?
25%
32
What is the likelihood of a patient having prostate cancer with PSA levels over 10ug/L?
40%
33
What is T0 in prostate cancer?
No tumour palpable
34
What is T1 in prostate cancer?
Tumour in one lobe of prostate
35
What is T2 in prostate cancer?
Tumour involving both prostate lobes
36
What is T3 in prostate cancer?
Tumour infiltrating out of prostate to involve seminal vesicles
37
What is T4 in prostate cancer?
Extensive tumour, fixed and infiltrating local structures
38
What is N0 in prostate cancer?
No lymph node involvement
39
What is N1 in prostate cancer?
Ipsilateral lymph nodes involved
40
What is N2 in prostate cancer?
Bilateral lymph node involvement
41
What is N3 in prostate cancer?
Fixed regional lymph nodes
42
What is N4 in prostate cancer?
Juxtaregional lymph nodes
43
What is M0 in prostate cancer?
No metastasis
44
What is M1 in prostate cancer?
Distant metastasis
45
(this was meant to be in investigations sorry) | What imaging investigations should be done in prostate cancer?
- Plain x-rays of chest and any sites of bone pain - Transrectal ultrasound - Bone scan
46
What are the basic grades of prostate cancer?
- Well differentiated - Moderately differentiated - Poorly differentiated
47
How can the grades of prostate cancer be further detailed?
Gleason grade
48
How does the Gleason grade work?
It scores tumours on a scale of 1-10, where 10 is the most poorly differentiated
49
What is the limitation of transurethral ultrasound?
Low specificity for malignancy
50
What is the strength of transurethral ultrasound?
High specificity for assessing the integrity of the prostatic capsule
51
What is transurethral ultrasound often combined with?
Needle biopsy
52
What samples are taken in needle biopsy in prostate cancer?
At least 6 cores of tissue
53
What is the role of MRI/CT in prostate cancer?
Used to investigate lymph node involvement
54
What are the treatment options for early stage (T1 or T2) prostate cancer?
- Watchful waiting - Radiotherapy - Radical prostatectomy
55
What are the options for watchful waiting in prostate cancer?
- Wait until patient presents with symptoms | - Active follow up of outpatients with regular PSA testing and physical examination
56
What is the advantage of watchful waiting in prostate cancer?
Does not produce physical or sexual complications associated with other treatments
57
What is the disadvantage of watchful waiting in prostate cancer?
May increase anxiety
58
When is watchful waiting the best option in prostate cancer?
- Men with low-grade, incidentally detected tumours | - Men with life expectancy of <10 years
59
What is the most commonly used treatment in the UK?
Radical radiotherapy
60
What causes the complications of radical radiotherapy in prostate cancer?
Damage to adjacent organs
61
What are the complications of radical radiotherapy in prostate cancer?
- Diarrhoea - Chronic proctitis - Incontinence - Impotence
62
What are the complications of radical prostatectomy?
- Operative mortality - Complete incontinence - Impotence
63
Who is radical radiotherapy more suitable for in prostate cancer?
Less fit patients
64
What is the disadvantage of radical radiotherapy compared to surgery in prostate cancer?
Survival data is worse than for surgery
65
How is locally advanced (T3/4) or metastatic prostate cancer treated?
Endocrine therapy
66
What are the options for endocrine therapy in locally advanced or metastatic prostate cancer?
- Orchidectomy - LHRH antagonists with or without anti-androgens - Oestrogens
67
Give 3 examples of anti-androgens
- Flutamide - Bicalutamide - Cyproterone acetate
68
What are the side effects of orchidectomy?
- Major psychological side effects - Impotence - Hot flushes
69
What might LHRH antagonists cause initially?
Initial increase in testosterone levels, that can cause tumour flare for first 1-2 weeks
70
What might the tumour flare in the first 1-2 weeks of LHRH antagonists cause?
Disease progression, causing; - Spinal cord compression - Ureteric obstruction - Increasing bone pain
71
How is disease progression caused by the tumour flare with LHRH antagonists prevented?
An anti-androgen should be started 3-7 days before the LHRH analogue injection, and continued for 3 weeks after it
72
How can metastatic bone pain be treated?
Irradiation to localised site, of if extensive, hemibody single fraction radiotherapy
73
Does chemotherapy have a role in prostate cancer?
New approaches using chemotherapy are under evaluation, but so far have produced disappointing results
74
Screenign
Dont forget to cover this, either in its own deck or at the end of this one
75
Is metastatic prostate cancer curable?
No (despite the effectiveness of initial hormone therapy)
76
What is the median survival after the development of androgen insensitivity in metastatic prostate cancer?
6-9 months
77
What is the survival rate of prostate cancer in patient with small bulk localised disease and well- to moderately differentiated tumours?
80% at 10 years

Z - Cancer Care Old (28 decks)

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