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Urology 2023 > Prostate cancer (module 4) > Flashcards

Prostate cancer (module 4) Flashcards

1
Q

anatomy and size of the prostate gland

A

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

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2
Q

the prostate gland is responsible for producing

A

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

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3
Q

incidence of prostate cancer

A

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

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4
Q

risks factors for prostate cancer

A

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.

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5
Q

early disease in prostate cancer

A

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

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6
Q

locally advanced disease symptoms

A

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

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7
Q

metastatic disease symptoms

A

bone pain, fractures, cord compression

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8
Q

investigations for diagnosis of prostate cancer

A

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

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9
Q

TRUS biopsy

A

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

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10
Q

potential complications of TRUS biopsy

A

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

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11
Q

how long might normal bleeding be seen after a TRUS biopsy

A

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

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12
Q

how many biopsies should be taken in a trus biopsy

A

usually like 12

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13
Q

is PSA prostate specific

A

yes but it is not cancer specific

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14
Q

what are some conditions that can cause elevated PSA

A

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

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15
Q

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

A

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

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16
Q

what should patients with elevated age related PSA have?

A

a DRE

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17
Q

what percentage of prostate cancer will be missed on DRE alone

A

45%

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18
Q

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

A

18%

19
Q

what investigations might be used for staging of prostate cancer

A

DRE (clinically)
CT or MRI pelvis
Isotope bone scan

20
Q

what do you use to grade prostate cancer

A

prostate biopsy - Gleason score

21
Q

what is the Gleason score

A

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

22
Q

95% of prostate tumours are

A

adenocarcinoma

23
Q

indication for radical prostatectomy

A

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

24
Q

how is a radical prostatectomy performed

A

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

25
Q

what length of stay will be needed for radical prostatectomy

A

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

26
Q

post operative management after radical prostatectomy

A

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

27
Q

complications of radical prostatectomy

A

impotence
incontinence
recusancy of disease
mortality

28
Q

two types of radiotherapy for prostate cancer

A

external beam radiotherapy (EBRT)
brachytherapy

29
Q

external beam radiotherapy

A

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

30
Q

what is brachytherapy

A

implanting radioactive material into the prostate

31
Q

two types of brachytherapy

A

seed brachytherapy
high dose rate brachytherapy

32
Q

seed brachytherapy

A

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

33
Q

high dose rate brachytherapy

A

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

34
Q

complications of radiotherapy

A

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

35
Q

androgen suppression agents

A

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

36
Q

LHRH agonist examples

A

goserelin (zoladex)
leupropelin (lucrin)

37
Q

anti-androgens examples

A

cyproterone acetate
biclutamide

38
Q

when should androgen suppression be prescribed

A

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

39
Q

advanced prostate cancer treatment

A

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

40
Q

bone complications from prostate cancer

A

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

41
Q

should prostate cancer be screened for?

A

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

42
Q

at what point does prostate cancer become symptomatic

A

usually only once it is advanced

43
Q

is prostate cancer usually curable?

A

yes

44
Q

does increased PSA level confirm a prostate cancer diagnosis?

A

no, you need histological diagnosis via a TRUS biopsy

Urology 2023 (7 decks)

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