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PHAM02 > prostate cancer JH > Flashcards

prostate cancer JH Flashcards

1
Q

signs and Sx of prostate cancer

A
  • 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
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2
Q

RF for prostate cancer

A
  • age (over 50yrs)
  • more common in African-Carribean
  • FHx - brother/father who developed it U60yrs increases risk
  • obesity
  • exercise
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3
Q

detection of prostate cancer

A
  1. DRE - digital rectal examination
  2. PSA test - prostate specific antigen test, mesures PSA in blood
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4
Q

What happens if DRE or PSA are abnormal?

A
  1. MRI
  2. transrectal ultrasound
  3. transperineal biopsy
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5
Q

score used to diagnose prostate cancer

A

Gleason score

ranges from 2-10

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6
Q

PSA and Gleason score for low risk localised prostate cancer

A

slow growing tumour

PSA < 10ng/ml

Gleason score < 7

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7
Q

Tx for low risk prostate cancer

A

active surveillance:
- PSA every 3-6 mths
- DRE every 6-12 mths

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8
Q

PSA and Gleason score for medium risk localised prostate cancer

A

PSA 10-20ng/L

Gleason score = 7

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9
Q

Tx for MEDIUM and HIGH risk prostate cancer

A
  • radical prostatectomy
  • radical external beam radiotherapy
  • radiotherapy and hormonal Tx
  • brachytherapy
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10
Q

PSA and Gleason score for high risk prostate cancer

A

PSA > 20ng/ml

Gleason score of 8, 9 or 10

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11
Q

When to move from active surveillance to radical Tx?

A

disease progression (low to med/high risk)

considering patient preference/comorbidity/life expectancy

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12
Q

When should brachytherapy NOT be offered?

A

to high risk localised PC

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13
Q

external beam radiotherapyXXXXXXXXXX

A

most common Tx

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14
Q

external beam radiotherapy

A
  • 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
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15
Q

ST s/e with external beam radiotherapy

A
  • urinary problems - frequency, urgency, retention
  • bowel problems - diarrhoea, wind, bleeding
  • fatigue
  • skin damage
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16
Q

LT s/e with external beam radiotherapy

A

ongoing urinary and bowel issues

ED

infertility

lymphodema

second cancers

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17
Q

What is brachytherapy?

A
  • 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
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18
Q

Is brachytherapy given alone?

A

not alone for high risk patients

can be given in combination with hormonal Tx or external beam radiotherapy

19
Q

Tx for locally advanced PC

A

radiotherapy

hormonal Tx

20
Q

Tx not recommended in locally advanced PC

A

radical surgery discouraged

21
Q

1st line hormonal therapy for PC

A

LHRH agonist

22
Q

initial s/e of LHRH agonist Tx

A

tumour flare in first 10 days

give anti-androgen tabs - cyproterone

23
Q

Tx for tumour flare initially with LHRH agonists

A

cyproterone

24
Q

How long are LHRH agonists given for?

A

6 months during radical radiotherapy

continued for 3yrs in high risk/locally advanced cancers

25
Q

examples of LHRH agonists

A

goserelin - Zoladex

leuprorelin - Prostrap

26
Q

s/e of hormonal therapies

A

increased risk of CVD

hot flushes

osteoporosis

lethargy

27
Q

Tx for hot flushes s/e with hormonal Tx (LHRH agonists)

A

medroxyprogesterone

28
Q

Tx for osteoporosis as s/e of hormonal therpaies

A

bisphosphonates or denosumab

calcium and Vit D

29
Q

Tx for lethargy as s/e with hormonal therapies

A

exercise may improve Sx

30
Q

Where can PC metastasise to?

A

bones

lymph nodes

organs

31
Q

Tx for metastatic PC

A

combined androgen blockade

  1. LHRH agonists inhibit testicular testosterone production
  2. anti-androgen blocks effects of remaining testosterone (produced from adrenal glands)
    - cyproterone (also used for tumour flare)
32
Q

% of PC that becomes castrate resistant

A

20%

33
Q

What is castrate resistant PC?

A

most cancers initially respond to androgen deprivation therapy

over time the cancer evolves

uses testosterone from other sources - adrenal androgens

34
Q

What can be used to reduce production of adrenal testosterone?

A

corticosteroids

35
Q

5 Tx options for PC

A
  1. docetaxel (taxame chemotherapy)
  2. Cabazitaxel (taxane chemotherapy)
  3. Enzalutamide (androgen R antagonist)
  4. Abiraterone ( CYP450 inhibitor involved in androgen production, for castrate resistant PC)
  5. Radium (bone seeking radioisotope)
36
Q

What type of drug is enzalutamide?

A

androgen receptor antagonist

37
Q

% of advanced PC that have bone metastases

A

80% of advanced PC

38
Q

How can PC cause bone metastases?

A

cancer cells can activate osteoclasts - bone resorption, weakens bone with no new bone formation

or stimulate osteoblasts - hardened/abnormal areas of bone

39
Q

bisphosphonates in PC

A
  • 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
40
Q

Sx of malignant spinal cord compression

A

back pain

motor dysfunction

neurological Sx

bladder/bowel issues

41
Q

Tx for malignant spinal cord compression

A

dexamethasone 16mg

monior blood sugars

42
Q

monitoring for dexamethasone Tx for spinal cord compression

A

monitor blood sugars

43
Q

other Tx options for malignant spinal cord compression

A

surgery

radiotherapy

-> to decompress spine

PHAM02 (32 decks)

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