Prostate Cancer (AAG) Flashcards
How common is prostate cancer in the UK, compared to other cancers?
It is the most common cancer in men
How many new cases of prostate cancer are there in the UK a year?
47,700
How many deaths from prostate cancer are there in the UK a year?
10,000
i’ve checked this, its right. seems like proportionally a lot but there ya go
What % of cases of prostate cancer occur in men over 70 years of age?
60%
What % of patients with prostate cancer have metastatic disease at presentation?
Nearly 50%
What % of patients with prostate cancer present with localised extracapsular spread?
25%
What has happened to the incidence of prostate cancer in recent years?
Substantial increases
What is causing the substantial increase in incidence of prostate cancer in recent years?
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
How does the reported incidence of prostate cancer differ in the USA compared to UK?
Up to 10x higher
What is the high incidence of prostate cancer in the USA compared to UK likely due to?
Effect of widespread prostate cancer screening
What is the most common type of prostate cancer?
Adenocarcinoma
What % of prostate cancers occur in the peripheral zone?
70%
What % of prostate cancers occur in the transitional zone?
20%
What % of prostate cancers occur in the central zone?
10%
In what % of prostate cancers is family history a feature?
10%
What might happen in patients with a family history of prostate cancer?
They might develop it at a younger age
What genes have been implicated in hereditary prostate cancer?
- BRCA1 and BRCA2 mutations
- HPC1 and BPC2 mutations
What are the racial differences in the incidence of prostate cancer?
Black > Caucasian > Asian (East and Southeast Asia, e.g. China)
What is the role of diet in prostate cancer?
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
How does the incidence of prostate cancer in vegetarians compare to that of omnivores?
50-75%
How does prostate cancer that is confined to the prostate present?
Completely asymptomatic
How do patients with a large component of benign prostatic hyperplasia, but with transitional zone prostate cancer, often present?
Bladder outlet obstruction, but no signs of prostate cancer
How are patients with a large component of benign prostatic hyperplasia with transitional zone prostate cancer often diagnosed?
Via transurethral resection
What is the most frequent presentation of locally advanced prostate cancer?
- Urinary frequency
- Poor urine flow
- Difficulty starting or stopping urination
What general features may be present in advanced prostate cancer?
- Bone pain
- Lethargy
- Weight loss
- Bilateral leg oedema
What causes bone pain in advanced prostate cancer?
Metastatic disease
What are the referral criteria for suspected asymptomatic prostate cancer?
Detection of raised PSA
What should be included in examination in a patient with prostate cancer?
- Rectal examination
- Surgery for focal bone tenderness
What routine blood tests are done in prostate cancer?
- Serum PSA
- FBC
- Acid and alkaline phosphatase
- Serum biochemistry
What is PSA?
A serine protease that dissolves prostatic coagulum
What is the likelihood of a patient having prostate cancer with PSA levels between 4-10 ug/L?
25%
What is the likelihood of a patient having prostate cancer with PSA levels over 10ug/L?
40%
What is T0 in prostate cancer?
No tumour palpable
What is T1 in prostate cancer?
Tumour in one lobe of prostate
What is T2 in prostate cancer?
Tumour involving both prostate lobes
What is T3 in prostate cancer?
Tumour infiltrating out of prostate to involve seminal vesicles
What is T4 in prostate cancer?
Extensive tumour, fixed and infiltrating local structures
What is N0 in prostate cancer?
No lymph node involvement
What is N1 in prostate cancer?
Ipsilateral lymph nodes involved
What is N2 in prostate cancer?
Bilateral lymph node involvement
What is N3 in prostate cancer?
Fixed regional lymph nodes
What is N4 in prostate cancer?
Juxtaregional lymph nodes
What is M0 in prostate cancer?
No metastasis
What is M1 in prostate cancer?
Distant metastasis
(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
What are the basic grades of prostate cancer?
- Well differentiated
- Moderately differentiated
- Poorly differentiated
How can the grades of prostate cancer be further detailed?
Gleason grade
How does the Gleason grade work?
It scores tumours on a scale of 1-10, where 10 is the most poorly differentiated
What is the limitation of transurethral ultrasound?
Low specificity for malignancy
What is the strength of transurethral ultrasound?
High specificity for assessing the integrity of the prostatic capsule
What is transurethral ultrasound often combined with?
Needle biopsy
What samples are taken in needle biopsy in prostate cancer?
At least 6 cores of tissue
What is the role of MRI/CT in prostate cancer?
Used to investigate lymph node involvement
What are the treatment options for early stage (T1 or T2) prostate cancer?
- Watchful waiting
- Radiotherapy
- Radical prostatectomy
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
What is the advantage of watchful waiting in prostate cancer?
Does not produce physical or sexual complications associated with other treatments
What is the disadvantage of watchful waiting in prostate cancer?
May increase anxiety
When is watchful waiting the best option in prostate cancer?
- Men with low-grade, incidentally detected tumours
- Men with life expectancy of <10 years
What is the most commonly used treatment in the UK?
Radical radiotherapy
What causes the complications of radical radiotherapy in prostate cancer?
Damage to adjacent organs
What are the complications of radical radiotherapy in prostate cancer?
- Diarrhoea
- Chronic proctitis
- Incontinence
- Impotence
What are the complications of radical prostatectomy?
- Operative mortality
- Complete incontinence
- Impotence
Who is radical radiotherapy more suitable for in prostate cancer?
Less fit patients
What is the disadvantage of radical radiotherapy compared to surgery in prostate cancer?
Survival data is worse than for surgery
How is locally advanced (T3/4) or metastatic prostate cancer treated?
Endocrine therapy
What are the options for endocrine therapy in locally advanced or metastatic prostate cancer?
- Orchidectomy
- LHRH antagonists with or without anti-androgens
- Oestrogens
Give 3 examples of anti-androgens
- Flutamide
- Bicalutamide
- Cyproterone acetate
What are the side effects of orchidectomy?
- Major psychological side effects
- Impotence
- Hot flushes
What might LHRH antagonists cause initially?
Initial increase in testosterone levels, that can cause tumour flare for first 1-2 weeks
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
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
How can metastatic bone pain be treated?
Irradiation to localised site, of if extensive, hemibody single fraction radiotherapy
Does chemotherapy have a role in prostate cancer?
New approaches using chemotherapy are under evaluation, but so far have produced disappointing results
Screenign
Dont forget to cover this, either in its own deck or at the end of this one
Is metastatic prostate cancer curable?
No (despite the effectiveness of initial hormone therapy)
What is the median survival after the development of androgen insensitivity in metastatic prostate cancer?
6-9 months
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
