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Z - Cancer Care Old > Prostate Cancer (AAG) > Flashcards

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
Q

What general features may be present in advanced prostate cancer?

A
  • Bone pain
  • Lethargy
  • Weight loss
  • Bilateral leg oedema
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26
Q

What causes bone pain in advanced prostate cancer?

A

Metastatic disease

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27
Q

What are the referral criteria for suspected asymptomatic prostate cancer?

A

Detection of raised PSA

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28
Q

What should be included in examination in a patient with prostate cancer?

A
  • Rectal examination

- Surgery for focal bone tenderness

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29
Q

What routine blood tests are done in prostate cancer?

A
  • Serum PSA
  • FBC
  • Acid and alkaline phosphatase
  • Serum biochemistry
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30
Q

What is PSA?

A

A serine protease that dissolves prostatic coagulum

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31
Q

What is the likelihood of a patient having prostate cancer with PSA levels between 4-10 ug/L?

A

25%

32
Q

What is the likelihood of a patient having prostate cancer with PSA levels over 10ug/L?

A

40%

33
Q

What is T0 in prostate cancer?

A

No tumour palpable

34
Q

What is T1 in prostate cancer?

A

Tumour in one lobe of prostate

35
Q

What is T2 in prostate cancer?

A

Tumour involving both prostate lobes

36
Q

What is T3 in prostate cancer?

A

Tumour infiltrating out of prostate to involve seminal vesicles

37
Q

What is T4 in prostate cancer?

A

Extensive tumour, fixed and infiltrating local structures

38
Q

What is N0 in prostate cancer?

A

No lymph node involvement

39
Q

What is N1 in prostate cancer?

A

Ipsilateral lymph nodes involved

40
Q

What is N2 in prostate cancer?

A

Bilateral lymph node involvement

41
Q

What is N3 in prostate cancer?

A

Fixed regional lymph nodes

42
Q

What is N4 in prostate cancer?

A

Juxtaregional lymph nodes

43
Q

What is M0 in prostate cancer?

A

No metastasis

44
Q

What is M1 in prostate cancer?

A

Distant metastasis

45
Q

(this was meant to be in investigations sorry)

What imaging investigations should be done in prostate cancer?

A
  • Plain x-rays of chest and any sites of bone pain
  • Transrectal ultrasound
  • Bone scan
46
Q

What are the basic grades of prostate cancer?

A
  • Well differentiated
  • Moderately differentiated
  • Poorly differentiated
47
Q

How can the grades of prostate cancer be further detailed?

A

Gleason grade

48
Q

How does the Gleason grade work?

A

It scores tumours on a scale of 1-10, where 10 is the most poorly differentiated

49
Q

What is the limitation of transurethral ultrasound?

A

Low specificity for malignancy

50
Q

What is the strength of transurethral ultrasound?

A

High specificity for assessing the integrity of the prostatic capsule

51
Q

What is transurethral ultrasound often combined with?

A

Needle biopsy

52
Q

What samples are taken in needle biopsy in prostate cancer?

A

At least 6 cores of tissue

53
Q

What is the role of MRI/CT in prostate cancer?

A

Used to investigate lymph node involvement

54
Q

What are the treatment options for early stage (T1 or T2) prostate cancer?

A
  • Watchful waiting
  • Radiotherapy
  • Radical prostatectomy
55
Q

What are the options for watchful waiting in prostate cancer?

A
  • Wait until patient presents with symptoms

- Active follow up of outpatients with regular PSA testing and physical examination

56
Q

What is the advantage of watchful waiting in prostate cancer?

A

Does not produce physical or sexual complications associated with other treatments

57
Q

What is the disadvantage of watchful waiting in prostate cancer?

A

May increase anxiety

58
Q

When is watchful waiting the best option in prostate cancer?

A
  • Men with low-grade, incidentally detected tumours

- Men with life expectancy of <10 years

59
Q

What is the most commonly used treatment in the UK?

A

Radical radiotherapy

60
Q

What causes the complications of radical radiotherapy in prostate cancer?

A

Damage to adjacent organs

61
Q

What are the complications of radical radiotherapy in prostate cancer?

A
  • Diarrhoea
  • Chronic proctitis
  • Incontinence
  • Impotence
62
Q

What are the complications of radical prostatectomy?

A
  • Operative mortality
  • Complete incontinence
  • Impotence
63
Q

Who is radical radiotherapy more suitable for in prostate cancer?

A

Less fit patients

64
Q

What is the disadvantage of radical radiotherapy compared to surgery in prostate cancer?

A

Survival data is worse than for surgery

65
Q

How is locally advanced (T3/4) or metastatic prostate cancer treated?

A

Endocrine therapy

66
Q

What are the options for endocrine therapy in locally advanced or metastatic prostate cancer?

A
  • Orchidectomy
  • LHRH antagonists with or without anti-androgens
  • Oestrogens
67
Q

Give 3 examples of anti-androgens

A
  • Flutamide
  • Bicalutamide
  • Cyproterone acetate
68
Q

What are the side effects of orchidectomy?

A
  • Major psychological side effects
  • Impotence
  • Hot flushes
69
Q

What might LHRH antagonists cause initially?

A

Initial increase in testosterone levels, that can cause tumour flare for first 1-2 weeks

70
Q

What might the tumour flare in the first 1-2 weeks of LHRH antagonists cause?

A

Disease progression, causing;

  • Spinal cord compression
  • Ureteric obstruction
  • Increasing bone pain
71
Q

How is disease progression caused by the tumour flare with LHRH antagonists prevented?

A

An anti-androgen should be started 3-7 days before the LHRH analogue injection, and continued for 3 weeks after it

72
Q

How can metastatic bone pain be treated?

A

Irradiation to localised site, of if extensive, hemibody single fraction radiotherapy

73
Q

Does chemotherapy have a role in prostate cancer?

A

New approaches using chemotherapy are under evaluation, but so far have produced disappointing results

74
Q

Screenign

A

Dont forget to cover this, either in its own deck or at the end of this one

75
Q

Is metastatic prostate cancer curable?

A

No (despite the effectiveness of initial hormone therapy)

76
Q

What is the median survival after the development of androgen insensitivity in metastatic prostate cancer?

A

6-9 months

77
Q

What is the survival rate of prostate cancer in patient with small bulk localised disease and well- to moderately differentiated tumours?

A

80% at 10 years

Z - Cancer Care Old (28 decks)

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