Prostate cancer (module 4) Flashcards by Monica Palumbo

anatomy and size of the prostate gland

sits at the base of the bladder, in front of the rectum
weighs approx 20g, size of a walnut

How well did you know this?

Not at all

Perfectly

the prostate gland is responsible for producing

30% of seminal fluid
seminal fluid contains enzymes indluding prostate specificc antigen

How well did you know this?

Not at all

Perfectly

incidence of prostate cancer

most common cancer for Australian men
often occurs after the age of 50
more prevalent in African men and less prevalent in Asian men

How well did you know this?

Not at all

Perfectly

risks factors for prostate cancer

genetic - family history increases risk
race - more often affects African men
dietary factors - may have a role but are controversial, high dietary fat is a risk factor.

How well did you know this?

Not at all

Perfectly

early disease in prostate cancer

early disease is usually asymptomatic
patients who present with LUTS usually have an enlarged prostate secondary to BPH though prostate cancer may coexist

How well did you know this?

Not at all

Perfectly

locally advanced disease symptoms

urinary symptoms similar to those in BPH
eg. frequency, nostril, hesitancy, poor stream, dysuria
haematuria may be present

How well did you know this?

Not at all

Perfectly

metastatic disease symptoms

bone pain, fractures, cord compression

How well did you know this?

Not at all

Perfectly

investigations for diagnosis of prostate cancer

digital rectal examination
- firm nodule is usually T2 disease
- hard, craggy prostate is usually T3 disease
PSA test
trans-rectal ultrasound biopsy (TRUS biopsy)

How well did you know this?

Not at all

Perfectly

TRUS biopsy

performed as a day case under local anaesthetic, sedation or general anaesthetic
biopsies taken through the rectum under ultrasound visualisation
usually 12 biopsies taken

How well did you know this?

Not at all

Perfectly

potential complications of TRUS biopsy

infection - (all pts get prophylaxis but infections can still occur)
bleeding - all pts may see blood PR, but serious post biopsy bleeding can also occur, all patients should stop anti coagulating drugs before biopsy
urinary retention

How well did you know this?

Not at all

Perfectly

how long might normal bleeding be seen after a TRUS biopsy

PR blood, haematuria and haematospermia may last several weeks
anti coagulating drugs must be stopped before a TRUS biopsy

How well did you know this?

Not at all

Perfectly

how many biopsies should be taken in a trus biopsy

usually like 12

How well did you know this?

Not at all

Perfectly

is PSA prostate specific

yes but it is not cancer specific

How well did you know this?

Not at all

Perfectly

what are some conditions that can cause elevated PSA

benign prostatic hyperplasia BPH
urinary tract infections
instrumentation eg. catheter
idiopathic

How well did you know this?

Not at all

Perfectly

what is the chances that the patient has cancer if the PSA is elevated but there’s no urinary tract infection?

PSA 4-10ng/ml = 25% chance
PSA >10ng/ml = 50% chance
PSA > 20ng/ml = 90% chance

How well did you know this?

Not at all

Perfectly

what should patients with elevated age related PSA have?

a DRE

How well did you know this?

Not at all

Perfectly

what percentage of prostate cancer will be missed on DRE alone

45%

How well did you know this?

Not at all

Perfectly

what percentage of prostate cancer will be missed on PSA testing alone

18%

what investigations might be used for staging of prostate cancer

DRE (clinically)
CT or MRI pelvis
Isotope bone scan

what do you use to grade prostate cancer

prostate biopsy - Gleason score

what is the Gleason score

used for grading prostate cancer
gives prognostic information and indicator of tumour aggression
histological grading system 1-5

95% of prostate tumours are

adenocarcinoma

indication for radical prostatectomy

localised prostate cancer
has been shown to improve survival in these men

how is a radical prostatectomy performed

can be performed as open retropubic operation or laparoscopically with or without robotic assistance

what length of stay will be needed for radical prostatectomy

approx 5 days or more, less if the operation was laparoscopic

post operative management after radical prostatectomy

catheter left in situ for 10 days post operatively not to be removed as reinsertion may disrupt urethral anastomosis

complications of radical prostatectomy

impotence incontinence recusancy of disease mortality

two types of radiotherapy for prostate cancer

external beam radiotherapy (EBRT) brachytherapy

external beam radiotherapy

given in fractions delivered over several weeks 3 dimensional conformational and intensity modulated techniques allow increased dose to be delivered to the prostate whilst minimising dose to rectum and other structures

what is brachytherapy

implanting radioactive material into the prostate

two types of brachytherapy

seed brachytherapy high dose rate brachytherapy

seed brachytherapy

permanently implanting radioactive seeds (iodine or palladium) into the prostate

high dose rate brachytherapy

temporary insertion of a high dose radioactive source to give a boost of treatment to the prostate usually combined with EBRT for high risk locally advanced disease

complications of radiotherapy

bladder and bowel irritation e.g. proctitis impotence disease recurrence

androgen suppression agents

prostate cancer is a testosterone dependant tumour androgens may be suppressed by - surgical castration - LHRH agonist - anti-androgens - oestrogens

LHRH agonist examples

goserelin (zoladex) leupropelin (lucrin)

anti-androgens examples

cyproterone acetate biclutamide

when should androgen suppression be prescribed

androgen suppression with an LHRH agonist is usually a palliative treatment but has been shown to improve survival when used in the adjuvant setting with radiotherapy

advanced prostate cancer treatment

40% of patients present with advanced disease mean survival 3-3.5 years usually require hormone manipulation GnRH agonist most frequently used therapy

bone complications from prostate cancer

testosterone is essential in maintaining bone mass in men and androgen suppression causes osteopenia and osteoporosis bone metastasis are common bone pain, fracture, spinal cord compression

should prostate cancer be screened for?

prostate cancer screening is controversial and there is little evidence suggesting that it would improve survival rates

at what point does prostate cancer become symptomatic

usually only once it is advanced

is prostate cancer usually curable?

yes

does increased PSA level confirm a prostate cancer diagnosis?

no, you need histological diagnosis via a TRUS biopsy