prostate cancer JD Flashcards
what are the signs and symptoms of prostate cancer?
*Difficulty starting urination
*Weak or interrupted flow of urine
*The need to urinate more frequently, especially at night
*Difficulty emptying the bladder completely
*Pain of burning during urination
*Pain in the back, hips, chest (ribs) or pelvis that
doesn’t go away
*Weakness of numbness in the legs or feet
*Erectile dysfunction
*Painful ejaculation
what are the risk factors associated with prostate cancer?
*Age (most cases are diagnosed in people
over 50)
*More common in men of African-Carribean
or African descent
*Family history – having a brother or father
who developed prostate cancer under the
age of 60 increases a person’s risk
*Obesity
*Exercise
what are the two ways in which to detect prostate cancer?
- Digital rectal exam
- Prostate-specific antigen (PSA) test: measures the level of PSA in the blood. PSA is made by the prostate. It is produced by normal and cancerous prostate cells.
how is diagnostics made?
if PSA or DRE is abnormal – diagnostic tests are
undertaken:
1. MRI scan
2. Transrectal ultrasound
3. Transperineal biopsy
what is gleason score?
this is determined when the biopsy is
looked at under the microscope. If there is a cancer, the score looks at how likely it is to spread. Score
ranges from 2-10.
when is localised prostate cancer low, medium and high risk?
Low risk
*Slow growing tumour
*PSA less than 10ng/mL
*Gleason score less than 7
*Medium risk
*PSA 10 – 20ng/mL
*Gleason score is 7
*High risk
*PSA above 20ng/mL
*Gleason score of 8, 9 or 10
how should you monitor low risk localised prostate cancer?
*Active surveillance
*PSA every 3-6 months
*DRE every 6-12 months
when would you move from active surveillence to radiacl treatment?
*Disease progression
*Considering patient preference, co-morbidity
and life expectancy
how would you treat medium to high risk localised prostate cancer?
*Radical prostatectomy
*Radical external beam radiotherapy
*Radiotherapy and hormonal treatment
Brachytherapy
what is external beam radiotherapy? how does it work?
*Most common treatment for UK men
*Destruction of cancer cells using focussed X-ray
radiation delivered from outside the body
when is external beam radiotherapy used?
Often used together with hormonal therapy or after surgery
what are the short and long term problems associated with external beam radiotherapy?
*Short term:
*Urinary problems – frequency, urgency, retention
*Bowel problems– diarrhoea, wind, bleeding
*Fatigue
*Skin damage
*Long term:
*Ongoing urinary and bowel issues
*Erectile dysfunction
*Infertility
*Lymphoedema
*Second cancers
what is brachytherapy?
*Delivers radiotherapy to the prostate from a
local internal source
*Uses permanently implanted seeds (low dose
rate) or temporary implanted wires directly into
the prostate (high dose rate)
when would you not used brachytherapy?
Not alone for high risk patients
*May be given in combination with hormonal
treatment or external beam radiotherapy
where does bradhytherapy deliver the radiation to?
Delivers radiation directly into the prostate
*Healthy tissue less likely to be damaged
what are the side effects of brachytherapy similar to?
EBRT
how do you treat locally advanced prostate cancer?
Radiotherapy
*Hormonal treatment
how does hormonal therapies work for prostate cancer?
LHRH agonist first line
*Tumour flare (10 days) – give anti-
androgen tablets e.g. cyproterone
*Normally given for 6 months during radical
radiotherapy
*But continued for 3 years in high risk/locally
advanced cancers
*Examples include goserelin (Zoladex)
what are the side effects of hormonal therapies?
*Side effects
*Increased risk of CVD
*Hot flushes
*Medroxyprogesterone
*Osteoporosis
*Bisphosphonates or denosumab
*Calcium and vitamin D
*Lethargy
*Exercise may improve symptoms
what is metastatic prostate cancer?
*Spread to other parts of the body
*Bones
*Lymph nodes
*Organs
what is the treatment required for metastatic prostate cancer?
Hormonal therapy (can control cancer for
several years)
*Chemotherapy (+ hormone therapy)
what is the combined androgen blockage?
*LHRH agonists inhibit testicular
testosterone production
*Anti-androgen blocks effect of remaining
testosterone (produced from adrenal
glands)
*e.g. cyproterone
*Also used to treat tumour flare
*AE include hot flushes, sweats, reduce
libido, gynaecomastia
how can you help treat castration resistant prostate cancer?
Can use corticosteroids as part of treatment
to reduce the production of adrenal
testosterone
what are the main treatment options of castration resistant prostate cancer?
*Docetaxel – taxane chemotherapy
*Cabazitaxel – taxane chemotherapy
*Enzalutamide – androgen receptor antagonist
Abiraterone – Cytochrome P450 inhibitor
involved in androgen production
*Radium – bone seeking radioisotope
what is bone homeostasis maintained by?
Bone resorption (osteoclasts)
*Bone formation (osteoblasts)
what can cancer cells activate/stimulate in bone metastasis?
Cancer cells can activate osteoclasts
*Weakens bone without new bone
formation
*Or stimulate osteoblasts
*Hardened/abnormal areas of bones
what are bisphosphonates used for in cancer?
*May be used for symptom relief
*Strengthens bones and reduces pain
*Can also be used to treat hypercalcaemia
*Zoledronic acid most potent and first line in
prostate cancer
*Given as an IV infusion
what are the symptoms of malignant spinal cord compression?
back pain, motor dysfunction,
neurological symptoms and bladder/bowel
issues
what treatment should be given for malignant spinal cord compression?
Commence dexamethasone 16mg
immediately
what should you monitor wen starting dexamethasone for malignant spinal cord compression?
Monitor blood sugars
