Prostate cancer (Complete) Flashcards
How common is prostate cancer in comparison to other cancers in males?
2nd most common cause of cancer
How does prostate cancer tend to present in early stages?
Presents mostly assymptomatic
What are the three main zones of the prostate?
Central zone: 25% of glandular tissue and contains ejaculatory ducts
Periphral zone: 70% of glandular tissue and largest zone
Transitional zone: 5% of glandular tissue and contains portion of prostatic urethra. [Composed mainly of transitional cells]
What zone of the prostate is typically enlarged in patients with benign prostatic hyperplasia?
Transitional zone
What are the main cell types which form glandular tissue in the prostate?
Basement membrane
Basal cells
Luminal cells
Neuroendocrine cells
Prostatic cancer is caused by gene mutations in which cell types?
Basal cells
or
Luminal cells
What gene mutations are involved in development of prostate adenocarcinoma?
BRCA1
BRCA2
Which region of the prostate does most prostate cancers tend to arise from?
Peripheral zone
Where does lymphatic spread of prostatic cancer first occur in?
Obturator nodes
Spread to which local extra prostatic region is associated with distant disease?
Spread to seminal vesicles
What are the main risk factors of prostate cancer?
Non-modifiable:
BRCA mutation
African ethnicity
Family history
Increasing age
Modifiable:
Obesity
High fat/milk diet
Smoking
What are the main signs/symptoms of prostate cancer in later stages?
Problems urinating (nocturia and increased frequency)
Poor stream of urine
Blood in semen
Discomfort in the pelvic area (Back, perineal or testicular pain)
Bone pain (Bone metasteses)
Erectile dysfunction
Abnormal DRE
What findings from DRE are suggestive of prostate cancer?
Feel a nodular which is:
Assymetric
Hard
Enlarged
Loss of median sulcus
What are the main investigations to consider in patients suspected of prostate cancer?
Bedside:
Urine dipstick
Digital rectal examination: Hard assymetrically enlarged nodule
Bloods:
PSA: Considered but poor sensitivity/specificity
Imaging/invasive:
MRI: Now considered first line
Transrectal ultrasound-guided biopsy [TRUS]: Used to be first line but now only done after MRI confirms likelihood of prostate cancer
What factors can result in elevated PSA?
Acute urinary retention
Benign Prosthetic Hypertrophy
Recent ejaculation
PR examination
Urethral instrumentation
Urinary tract infection
Prostatitis
Prostate cancer
Which men should be reffered for further prostate cancer investigations?
Men with abnormal DRE
Men 50-69 years of age with PSA > 3.0ng/ml
What scale is used when interpreting MRI findings to determine likelihood of prostate cancer?
Likert scale
What score on Likert scale is should indicate further testing is needed to check for prostate cancer?
3 or more
List complications of TRUS biopsy
Sepsis (1% of cases)
Fever (5% of cases)
Haematuria and rectal bleeding
Pain lasting >2 weeks (15%) and can be severe in 7% of cases
What does NICE reccomend to inform patients of who have Likert scale of 1-2?
Inform them of consequences of having a biopsy
What further investigations are ordered after MRI?
Biopsy: Confirms diagnosis of prostate cancer
CT: If metastatic disease suspected
Bone isotope scan: If bone metasteses suspected
What scoring system is used to grade prostate cancer?
Gleason grading system
How should gleason scores be interpreted?
Lower gleason score associated with better prognosis and less intervention
Higher gleason score associated with poor prognosis and more aggresive
What are some management options for patients diagnosed with localised prostate cancer?
Depends on life expectancy and patient choice
Conservative:
Watchful waiting or active monitoring
Surgical/Invasive:
Radical prostatectomy
Radiotherapy (Curative or palliative)
Active surveillance is reccomended for which types of patients and why?
Patients with low-grade prostate cancer
This helps to prevent overtreatment of this patient group and treatment can then be re-assesed if grade changes overtime
What investigations are involved in active monitoring for patients with low-grade prostate cancer?
PSA
DRE
Biopsies
What management options are reccomended for patients with locally advanced prostate cancer?
Hormonal therapy
Radical prostatectomy
Radiotherapy
What is a common complication of radical prostatectomy?
Erectile dysfunction
What are complications of radiotherapy in treatment of prostate cancer?
Increased risk of:
Bladder cancer
Colonrectal cancer
Proctitis
What is the reccomended mangement plan for patients with metastatic prostate cancer?
Hormonal therapy
OR
Chemotherapy with docetaxel
What is the main aim of hormonal therapy?
Reduce androgen levels
What are the three main hormonal therapy treatment options?
GnRH analouges: e.g. Gosereline and leuprolide
Androgen antagonists: E.g. Bicalutamide and Enzalutamide.
GnRH antagonsists: E.g. Degarelix
What is the role of GnRH analouges?
Name 2 examples of GnRH analougues
Paradoxically block LH and FSH due to overstimulation.
Goserelin
Leuprolide
What are issues of GnRH analouges?
Can initially progress disease activity due to transient rise in testosterone
What is offered alongiside GnRH analougues to minimise complications?
Androgen antagonsists
Prevent an increase in disease activity following a transient surge in LH & FSH
Name 2 examples of androgen antagonists
Bicalutamide
Enzalutamide
Name an example of a GnRH antagonist
Degarelix
What are sexual side effects of hormonal therapy in treatment of prostate cancer? (4)
Decreased labido
Impotence
Infertility
Gynecomastia
What are metabolic side effects of hormonal therapy in treatment of prostate cancer?
Weight gain
Osteoporosis
Diabetes
Ischaemic heart disease
What haematological side effects is asscoiated with hormonal therapy?
Anaemia
