prostate cancer JH Flashcards
signs and Sx of prostate cancer
- difficulty starting urination
- weak/interrupted flow
- need to urinate frequently, especially at night
- difficulty emptying bladder completely
- pain/burning during urination
- pain in back/hips/chest (ribs)/pelvis that doesn’t go away
- weakness/numbness in feet/legs
- ED
- painful ejactulation
RF for prostate cancer
- age (over 50yrs)
- more common in African-Carribean
- FHx - brother/father who developed it U60yrs increases risk
- obesity
- exercise
detection of prostate cancer
- DRE - digital rectal examination
- PSA test - prostate specific antigen test, mesures PSA in blood
What happens if DRE or PSA are abnormal?
- MRI
- transrectal ultrasound
- transperineal biopsy
score used to diagnose prostate cancer
Gleason score
ranges from 2-10
PSA and Gleason score for low risk localised prostate cancer
slow growing tumour
PSA < 10ng/ml
Gleason score < 7
Tx for low risk prostate cancer
active surveillance:
- PSA every 3-6 mths
- DRE every 6-12 mths
PSA and Gleason score for medium risk localised prostate cancer
PSA 10-20ng/L
Gleason score = 7
Tx for MEDIUM and HIGH risk prostate cancer
- radical prostatectomy
- radical external beam radiotherapy
- radiotherapy and hormonal Tx
- brachytherapy
PSA and Gleason score for high risk prostate cancer
PSA > 20ng/ml
Gleason score of 8, 9 or 10
When to move from active surveillance to radical Tx?
disease progression (low to med/high risk)
considering patient preference/comorbidity/life expectancy
When should brachytherapy NOT be offered?
to high risk localised PC
external beam radiotherapyXXXXXXXXXX
most common Tx
external beam radiotherapy
- most common Tx
- destruction of cancer cells using focussed x-ray radiation delivered from outside the body
- often used with hormonal therpay or after surgery
- painless Tx but has s/e
ST s/e with external beam radiotherapy
- urinary problems - frequency, urgency, retention
- bowel problems - diarrhoea, wind, bleeding
- fatigue
- skin damage
LT s/e with external beam radiotherapy
ongoing urinary and bowel issues
ED
infertility
lymphodema
second cancers
What is brachytherapy?
- delivers radiotherapy to prostate from a local internal source
- uses permanently implanted seeds (low dose)
or - temporary implanted wires (high dose) directly into prostate
- delivers radiation directly into prostate
- healthy tissues less likely to be damaged
- s/e same to external beam radiotherapy
- usually requires general/spinal anaesthetic
- often given ABX to prevent infection
Is brachytherapy given alone?
not alone for high risk patients
can be given in combination with hormonal Tx or external beam radiotherapy
Tx for locally advanced PC
radiotherapy
hormonal Tx
Tx not recommended in locally advanced PC
radical surgery discouraged
1st line hormonal therapy for PC
LHRH agonist
initial s/e of LHRH agonist Tx
tumour flare in first 10 days
give anti-androgen tabs - cyproterone
Tx for tumour flare initially with LHRH agonists
cyproterone
How long are LHRH agonists given for?
6 months during radical radiotherapy
continued for 3yrs in high risk/locally advanced cancers
examples of LHRH agonists
goserelin - Zoladex
leuprorelin - Prostrap
s/e of hormonal therapies
increased risk of CVD
hot flushes
osteoporosis
lethargy
Tx for hot flushes s/e with hormonal Tx (LHRH agonists)
medroxyprogesterone
Tx for osteoporosis as s/e of hormonal therpaies
bisphosphonates or denosumab
calcium and Vit D
Tx for lethargy as s/e with hormonal therapies
exercise may improve Sx
Where can PC metastasise to?
bones
lymph nodes
organs
Tx for metastatic PC
combined androgen blockade
- LHRH agonists inhibit testicular testosterone production
- anti-androgen blocks effects of remaining testosterone (produced from adrenal glands)
- cyproterone (also used for tumour flare)
% of PC that becomes castrate resistant
20%
What is castrate resistant PC?
most cancers initially respond to androgen deprivation therapy
over time the cancer evolves
uses testosterone from other sources - adrenal androgens
What can be used to reduce production of adrenal testosterone?
corticosteroids
5 Tx options for PC
- docetaxel (taxame chemotherapy)
- Cabazitaxel (taxane chemotherapy)
- Enzalutamide (androgen R antagonist)
- Abiraterone ( CYP450 inhibitor involved in androgen production, for castrate resistant PC)
- Radium (bone seeking radioisotope)
What type of drug is enzalutamide?
androgen receptor antagonist
% of advanced PC that have bone metastases
80% of advanced PC
How can PC cause bone metastases?
cancer cells can activate osteoclasts - bone resorption, weakens bone with no new bone formation
or stimulate osteoblasts - hardened/abnormal areas of bone
bisphosphonates in PC
- used for Sx relief
- strengthens bones and reduces pain
- also used to treat hypercalcaemia
- Zolendronic acid most potent, 1st line for PC
-> given as IV infusion
Sx of malignant spinal cord compression
back pain
motor dysfunction
neurological Sx
bladder/bowel issues
Tx for malignant spinal cord compression
dexamethasone 16mg
monior blood sugars
monitoring for dexamethasone Tx for spinal cord compression
monitor blood sugars
other Tx options for malignant spinal cord compression
surgery
radiotherapy
-> to decompress spine
