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Tutorials > Prostate cancer tutorial > Flashcards

Prostate cancer tutorial Flashcards

1
Q

Epidemiology of prostate cancer in males in UK

A

most common cancer in UK males. 2nd mortality after lung cancer. Has had an increasing incidence

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2
Q

Causes of prostate cancer

A

hetergoeneous, environments and genetics

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3
Q

Hypotheses for cause of familial (genetic) prostate cancer

A

PTEN (tumour suppressor gene) inactivation leading to autonomous activation of androgen receptor (shown to antagonise androgen receptor signalling pathway) or facilitates anti-apoptotic pathways

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4
Q

Clinical presentation of prostate cancer

A

Problems urinating

less common lower back pain and haematuria

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5
Q

Normal physiological role of prostate gland

A

exocrine gland, production of seminal fluid released into prostatic part of urethre, component of ejaculate, necessary for male fertility

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6
Q

frequent sites of metastasis of prostate cancer

A

seminal vesicles, bladder

lymph nodes and bones

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7
Q

What is PSA?

A

Prostate specific antigen

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8
Q

describe and explain Normal PSA levels in blood

A

Normally undetectable PSA due to inability to pass through gap junctions/BM of luminal ep cells of prostate

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9
Q

Describe and explain PSA levels in prostate cancer/BPH

A

Elevated due to hyperplasia and leakage into blood so detectable (cancer usually grows disorganised so lack of junction/invasion past BM)

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10
Q

WHat is BPH? Who does usually affect?

A

Benign prostatic hyperplasia
Hyperplasia of prostate gland not associated with malignancy
Most >50y males

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11
Q

What is the cut off for PSA above which further investigation need to be conducted?

A

4ng/ml serum

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12
Q

Reasons for elevated PSA not cancer

A

bike riding, exercise, UTI, post-biopsy, prostatitis, anal sex

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13
Q

Tests done after +ve elevated PSA

A

biopsy and tumour grading, digital rectal exam, MRI scan

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14
Q

Scoring system used to grade prostate cancers

A

Gleason score

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15
Q

Nature of prostate cancers

A

slow-growing “pussycats” or aggressive “tigers” and life-threatening due to throwing off metastases that usually cause bone involvement

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16
Q

“treatment” for low grade/slow growing prostate malignant cancer

A

nothing, watchful waiting by doing regular tests

17
Q

Treatments of prostate cancers confined to prostate gland exclusively

A

Radical prostatectomy surgery (highest survival PSA<10-12ng/ml and <70yo)
Targeted external beam radiotherapy
Brachytherapy = implantation of radioactive seeds into prostate

18
Q

SE of prostatectomy/radiotherapy/brachytherapy

A

inontinence, pudendal nerve damage -> impotence

19
Q

Principle for hormone therapy in prostate cancer

A

Androgens stimulate prostatic growth via androgen receptor, so can be used to halt tumour progression/growth

20
Q

Treatment options in hormone therapy and explanation

A

Chemical bilateral orchidectomy causing most androgen production to cease
Anti-androgens

21
Q

Mechanism of Chemical bilateral orchidectomy

A

LHRH agonist used

Causes desenitisation of pituiatry gonadotrophs, so LH production ceases and testosterone/androgen prod also ceases

22
Q

MOA of antiandogens

A

Androgen receptor antagonists

23
Q

SE of hormone therapy

A

osteoporosis, loss of libido, muscle atrophy, memory loss, gynaecomastia

24
Q

Explain androgen independence in prostate tumours after effective hormone therapy

A

Prostate cancers can become symptomatic and usually more aggressive after hormone therapy

25
Q

Mechanisms of androgen indepence

A

Androgen receptor overexpression -> amplifieed response to remaining circulating weak androgens
Androgen receptor structural change -> activity change, activated by other ligands eg oestrogen
Upregulation of signalling molecules in androgen receptor
Target gene amplification
Decreased levels of co-repressors (antagonists)

26
Q

Examples of antiandrogens

A

Flutamide, Nilutamide

27
Q

Scoring system used in prostate cancer

A

Gleason scoring system

28
Q

Describe the Gleason scoring system

How is the Gleason score quoted and what does it mean?

A

Gleason is a scale from 1-5. 1 being identical to prostate gland = small uniform glands, 5 being undifferentiated, unrecognizable. The higher the score, the worse the prostate cancer and the worse the prognosis

It is quoted as 2 numbers on the scale and their total
eg 3+4=7
the first number refers to the majority score of the biopsy and the second to the second most prervalent

29
Q

Why does the Gleason score quote 2 numbers?

A

Prostate cancer differentiation is highly variable (which is also why many biopsies are taken from multiple parts of the gland)

Tutorials (3 decks)

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