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URO - Urology > Prostate Carcinoma > Flashcards

Prostate Carcinoma Flashcards

1
Q

Epidemiology of Prostate Carcinoma.

A
  1. Commonest cancer in men and risk increases with age.

2. 2nd commonest cause of death due to cancer after lung cancer.

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2
Q

Risk Factors of Prostate Carcinoma (6).

A
  1. Increasing Age.
  2. Family History (Lynch Syndrome, Germline BRCA Mutations).
  3. Afro-Caribbean Ethnicity.
  4. Tall Stature.
  5. Use of Anabolic Steroids.
  6. Obesity.
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3
Q

Clinical Presentation of Prostate Carcinoma (4).

A
  1. Similar to BPH.
  2. Haematuria, Erectile Dysfunction.
  3. Constitutional Symptoms.
  4. Asymptomatic.
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4
Q

Bony Metastasis of Cancers (2).

A
  1. Prostate Bony Metastases - Osteosclerotic vs. Other Cancer Bony Metastases - Osteolytic.
  2. Isotope (Radionuclide/Bone Scintigraphy) Scan - IV Injection of radioactive isotope to see bone uptake using a gamma camera.
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5
Q

Which cancers commonly metastasise to bones? (5)

A

BLTPK - Breast, Lung, Thyroid, Prostate, Kidney..

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6
Q

Pathophysiology of Prostate Carcinoma (3).

A
  1. 95% - Adenocarcinomas (glandular epithelial cells lining the glands/ducts of prostate).
  2. 70% lie in Peripheral Zone and multifocal.
  3. Always androgen-dependent.
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7
Q

Lymphatic Spread of Prostatic Carcinoma.

A

First to Obturator Nodes and then local extra prostatic spread to the seminal vesicles (distant disease).

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8
Q

What is PIN?

A

Prostatic Intraepithelial Neoplasia - precursor of Prostatic Adenocarcinoma (asymptomatic).

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9
Q

What is PSA?

A

Prostate-Specific Antigen - a serine protease glycoprotein secreted by epithelial cells of the prostate into semen (enzymatic activity to thin thick semen into liquid consistency after ejaculation), with a small amount entering the blood.

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10
Q

Values of PSA in People (3).

A
  1. Upper Limit in 50s = 3.0
  2. Upper Limit in 60s = 4.0.
  3. Upper Limit in 70s = 5.0.
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11
Q

Differential Diagnoses of Raised PSA (7).

A
  1. Prostate Carcinoma.
  2. BPH.
  3. Prostatitis (NICE recommend postponing for 1 month after treatment).
  4. UTI.
  5. Vigorous Exercise (notably cycling - avoid for 48 hours).
  6. Recent Ejaculation (avoid for 48 hours).
  7. Prostate Stimulation e.g. DRE - avoid for 48 hours.
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12
Q

Staging of Prostate Carcinoma.

A

TNM - use CT/MRI and Bone Scan.

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13
Q

Grading of Prostate Carcinoma (2).

A
  1. Gleason - grade I - well-differentiated; grade V - poorly-differentiated.
  2. 2 scores (1-5 each) : 1st score is based on grade of most prevalent pattern; 2nd score is based on grade of 2nd most prevalent pattern.
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14
Q

1st Line Investigation for Suspected Localised Prostatic Carcinoma.

A

Multiparametric MRI of the Prostate, scored on a Likert Scale - 1 very low suspicion; 3 - equivocal; 5 - definite cancer.

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15
Q

Prostate Biopsy (4).

A
  1. Definitive Method to diagnose Prostate Cancer.
  2. TRUS (Transurethral US-Guided Biopsy) - US inserted into rectum and needle biopsy through rectal wall into Prostate under US guidance.
  3. 12 biopsies taken.
  4. With Transperineal Biopsy - around 35 biopsies; higher sensitivity; longer and GA.
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16
Q

Management of Prostate Carcinoma (5).

A
  1. Early Case - Watchful Waiting (or elderly, multiple co-morbidities, low Gleason).
  2. External Beam Radiotherapy.
  3. Brachytherapy.
  4. Hormonal Therapy.
  5. Surgical Management.
17
Q

What is Brachytherapy?

Adverse Effects of Brachytherapy (3).

A
  1. Radioactive seeds are implanted into the prostate to deliver continuous targeted radiotherapy.
  2. Adverse Effects : Urinary Incontinence, Erectile Dysfunction, Long-Term Bowel/Bladder Problems.
18
Q

What is External Beam Radiotherapy?

What is a major complication of EBR?

A
  1. Radiotherapy directed at the Prostate.

2. Complication : Proctitis (Rectum Inflammation) - Use Prednisolone Suppositories.

19
Q

What is the rationale of Hormonal Therapy?

A

Prostate tissue grows in response to androgens like Testosterone so hormonal therapy aims to block Androgens to slow/stop the growth of Prostate Cancer.

20
Q

What are the 3 options of Hormonal Therapy?

A
  1. Bilateral Orchidectomy (Gold-Standard).
  2. GnRH Agonists (Chemical Castration e.g. Goserelin).
  3. Androgen-Receptor Blockers e.g. Bicalutamide, Cyproterone Acetate.
21
Q

What is the mechanism of action of Cyproterone Acetate?

A

Prevents DHT binding from intracytoplasmic protein complexes.

22
Q

What is the mechanism of action of Bicalutamide?

A

Non-steroidal anti-Androgen that blocks Androgen receptors.

23
Q

What is the mechanism of action of synthetic GnRH agonists?

A

Paradoxically result in lower LH levels longer term by causing overstimulation by resulting in the disruption of endogenous hormonal feedback systems.

24
Q

Adverse Effect of GnRH Agonists (3).

A
  1. Testosterone level will rise initially for around 2-3 weeks before falling to cassation levels.
  2. ‘Tumour Flare ‘ - cover this therapy with Anti-Androgen initially.
  3. Tumour Flare can result in stimulation of prostate cancer growth e.g. bone pain, bladder obstruction.
25
Q

What is the Surgical Management of Prostatic Carcinoma?

A

Total Prostatectomy - standard treatment for localised disease - obturator nodes are also removed. The bladder is rejoined to the urethra.

26
Q

Prognosis of Prostate Cancer.

A

SLOW - 10% die in 6 months; 10% live for more than 10 years.

URO - Urology (17 decks)

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