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Year 3 > Prostate cancer (URO) > Flashcards

Prostate cancer (URO) Flashcards

1
Q

What is prostate cancer?

A

A malignant tumour of glandular origin (adenocarcinoma), situated in the prostate

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2
Q

How common is prostate cancer?

A

Second most common cancer in men worldwide

Fifth leading cause of cancer mortality in men worldwide

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3
Q

When does prostate cancer commonly happen?

A

Most common after 50y, median age 67y

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4
Q

How does prostate cancer develop?

A

High-grade prostatic intra-epithelial neoplasia (precursor) –> invasive prostate cancer

Spreads along capsular surface of gland –> seminal vesicles –> peri-prostatic tissues –> bladder neck

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5
Q

Where can prostate cancer metastasise to? (Most to least common)

A
  • bone
  • lung
  • liver
  • pleura
  • adrenals
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6
Q

What are the types of prostate cancer? (3)

A
  • adenocarcinomas - most common, arise from glandular tissues from luminal/basal cells
  • transitional cell carcinoma - arises from prostatic urethra transitional epithelium cells
  • small cell prostate cancer - arise from neuroendocrine cells
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7
Q

What are some risk factors for prostate cancer? (6)

A
  • age >50
  • positive Fx
  • genetics - BRCA1/BRCA2 mutations, HOXB13
  • black ethnicity
  • Northwest European, Caribbean, Australian, NZ, North American and Southern African populations
  • high levels of dietary fat
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8
Q

What are the general clinical features of prostate cancer? (3)

A
  • often asymptomatic
  • may present with complicated LUTS - urinary retention, haematuria, incontinence, flank pain, nocturia, frequency, hesitancy
  • abnormal DRE - asymmetrical, hard, nodular enlargement of prostate, loss of midline sulcus
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9
Q

What LUTS are seen in prostate cancer? (7)

A
  • urinary retention
  • haematuria
  • incontinence
  • flank pain
  • nocturia
  • frequency
  • hesitancy
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10
Q

What is seen on DRE in prostate cancer? (4)

A
  • asymmetrical
  • hard
  • nodular enlargement of prostate
  • loss of midline sulcus
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11
Q

What are the clinical features of advanced/metastatic prostate cancer? (6)

A
  • fatigue & malaise
  • weight loss
  • bone pain
  • neurological deficits (SC compression)
  • lymphoedema
  • paraneoplastic syndromes
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12
Q

What are the main investigations done for prostate cancer?

A
  • serum PSA
  • prebiopsy multiparametric MRI
  • prostate biopsy (transrectal US-guided needle biopsy)
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13
Q

What is now the first-line investigation for prostate cancer?

A

Multiparametric MRI

(If PSA >3 and/or suspicious DRE)

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14
Q

What is the gold standard investigation for prostate cancer?

A

Transrectal ultrasound-guided needle biopsy

  • may detect adenocarcinoma
  • Gleason staging
  • if 3+ on Likert scale after multiparametric MRI
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15
Q

What antigen can you measure to detect prostate cancer?

A

Prostate-specific antigen (PSA)

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16
Q

What is the issue with using PSA in prostate cancer?

A

Not cancer-specific –> elevated in benign conditions:

  • BPH
  • UTI
  • prostatitis
17
Q

At what PSA level is prostate cancer likely?

A

Elevated PSA >4 ng/mL - but correlate with patient age

18
Q

What physical exam can you perform for prostate cancer?

A

DRE - asymmetrical, hard, nodular enlargement of prostate, loss of midline sulcus

19
Q

Why may you do a bone scan in prostate cancer?

A

To check for metastases

20
Q

What may be raised if there are bone metastases in prostate cancer?

A

ALP

21
Q

Which investigations can help stage prostate cancer?

A

Pelvic CT/MRI

MRI spine to look for metastases causing spinal cord compression –> can lead to incontinence and weakness

22
Q

What is the grading system for prostate cancer?

A

Gleason score (lower score = better prognosis)

  • biopsy specimen given a score from 1-5 based on the degree of architectural differentiation of the tumour
  • Gleason score obtained by assigning a primary grade to the predominant grade present, and a secondary grade to the second most prevalent grade
  • e.g. tumour with grade 3 and grade 2 cells = Gleason score 5
23
Q

What do different Gleason scores mean for prostate cancer?

A
  • low-grade tumour: Gleason score </=6
  • intermediate-grade tumour: Gleason score 7
  • high-grade tumour: Gleason score 8-10
24
Q

What are some differential diagnoses for prostate cancer? (2)

A
  • BPH - prostate feels rubbery with no nodules
  • chronic prostatitis - Sx of urinary frequency, dysuria, male dyspareunia and haematospermia
25
Q

What is the management plan for localised (T1/T2) prostate cancer?

A
  • watchful waiting: PSA every 6m, DRE every 12m
  • PLUS active surveillance if life expectancy >10y: regular biopsy (intention to treat once Sx of disease become clinically evident)
26
Q

What does localised advanced prostate cancer score on the Gleason staging system?

A

T3/T4

27
Q

What is the management plan for localised advanced (T3/T4) prostate cancer? (2)

A
  • radical prostatectomy +/- lymph node dissection
  • radiotherapy (external beam or brachytherapy - internal radiotherapy directly to prostate)
28
Q

What is a common complication of radical prostatectomy?

A

Erectile dysfunction

29
Q

What does radiotherapy (prostate cancer) increase risk of?

A

Bladder, colon and rectal cancer
Proctitis

30
Q

What is the management plan for metastatic prostate cancer?

A

Hormonal therapy (anti-androgen therapy) - combination often used:

  • GnRH agonists - Goserelin
  • androgen antagonists - Bicalutamide, Enzalutamide
  • GnRH antagonists - Degarelix
31
Q

What are the side effects of GnRH agonists (Goserelin) for prostate cancer? (4)

A
  • gynaecomastia
  • decreased libido
  • ED
  • infertility
32
Q

What can initial treatment with GnRH agonists in metastatic prostate cancer cause, and how can we prevent this?

A

Tumour flare - bone pain, bladder obstruction

Give cyproterone acetate + pre-treatment with flutamide

33
Q

What are some complications of prostate cancer? (5)

A
  • erectile dysfunction - from radiation, prostatectomy or hormone therapy
  • metastases - bone, lung, liver, pleura, adrenals
  • compression of bladder and prostatic urethra –> pain on ejaculation + bleeding
  • radiotherapy-induced effects
  • hormone-induced effects
34
Q

What are the NICE guidelines regarding PSA testing?

A

Due to these things causing increased PSA levels, testing should not be done within at least:

  • 6 weeks of a prostate biopsy
  • 4 weeks following a proven UTI
  • 1 week of DRE
  • 48h of vigorous exercise
  • 48h of ejaculation

Year 3 (191 decks)

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