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)
