Prostate cancer (URO) Flashcards

1
Q

What is prostate cancer?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How common is prostate cancer?

A

Second most common cancer in men worldwide

Fifth leading cause of cancer mortality in men worldwide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When does prostate cancer commonly happen?

A

Most common after 50y, median age 67y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A
  • bone
  • lung
  • liver
  • pleura
  • adrenals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What LUTS are seen in prostate cancer? (7)

A
  • urinary retention
  • haematuria
  • incontinence
  • flank pain
  • nocturia
  • frequency
  • hesitancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A
  • asymmetrical
  • hard
  • nodular enlargement of prostate
  • loss of midline sulcus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the main investigations done for prostate cancer?

A
  • serum PSA
  • prebiopsy multiparametric MRI
  • prostate biopsy (transrectal US-guided needle biopsy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

Multiparametric MRI

(If PSA >3 and/or suspicious DRE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What antigen can you measure to detect prostate cancer?

A

Prostate-specific antigen (PSA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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?

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
What is the management plan for localised (T1/T2) prostate cancer?
- 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
What does localised advanced prostate cancer score on the Gleason staging system?
T3/T4
27
What is the management plan for localised advanced (T3/T4) prostate cancer? (2)
- radical prostatectomy +/- lymph node dissection - radiotherapy (external beam or brachytherapy - internal radiotherapy directly to prostate)
28
What is a common complication of radical prostatectomy?
Erectile dysfunction
29
What does radiotherapy (prostate cancer) increase risk of?
Bladder, colon and rectal cancer Proctitis
30
What is the management plan for metastatic prostate cancer?
Hormonal therapy (anti-androgen therapy) - combination often used: - GnRH agonists - Goserelin - androgen antagonists - Bicalutamide, Enzalutamide - GnRH antagonists - Degarelix
31
What are the side effects of GnRH agonists (Goserelin) for prostate cancer? (4)
- gynaecomastia - decreased libido - ED - infertility
32
What can initial treatment with GnRH agonists in metastatic prostate cancer cause, and how can we prevent this?
Tumour flare - bone pain, bladder obstruction Give cyproterone acetate + pre-treatment with flutamide
33
What are some complications of prostate cancer? (5)
- 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
What are the NICE guidelines regarding PSA testing?
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