Prostate carcinoma Flashcards
How common is it?
0.45% prevalence
Who does it affect?
About 25% of all new cases of cancer in men are prostate cancer, making it the most common type of cancer in men
Malignant change within the prostate is increasingly common with increasing age, being present in 80% of men aged 80 and over. In most cases these malignant foci remain dormant.
What causes it?
FHx, ethnicity
Genetic mutations (mostly spontaneous) affecting the androgen receptor in prostatic cells are known to play an important role in the development of prostate cancer.
The androgen receptor is involved in prostate cell signalling, prostate cell growth, and spread of prostate cancer. Prostate cancer can therefore be treated hormonally by androgen blockade or withdrawal, but as the cancer develops, further mutations can affect the androgen receptor and allows them to function without androgen (thus making this hormonal treatment ineffective).
What risk factors are there?
Increasing age.
Ethnicity: men with black African or Black Caribbean ancestry are at the highest risk.
Family history of prostate cancer:
BRCA gene mutation. Men with the BRCA1 or BRCA 2 gene mutations have a 30% increased risk.
How does it present?
In developed countries, many patients now present as a result of screening for prostate cancer by measurement of serum PSA although this test is shit and you shouldn’t do it.
Symptoms are identical to BPH causing outflow obstruction (increased frequency of micturition, nocturia, delay in initiation of micturition and post-void dribbling are common symptoms.
Acute urinary retention or retention with overflow incontinence also occurs).
Occasionally, presenting symptoms are due to metastases, particularly to bone.
Signs on examination?
Hard irregular gland.
Investigations
Transrectal US of the prostate
elevated serum PSA (shit)
transrectal prostate biopsy
If mets are present serum PSA is usually markedly elevated.
Endorectal coil MRI is used to locally stage the tumour.
Treatment
Microscopic tumour is sometimes managed by watchful waiting.
Treatment of disease confined to the gland is radical prostatectomy or radiotherapy, both resulting in an 80-90% 5 year survival.
The treatment of metastatic disease depends on removing androgenic drive to the tumour. This is achieved by bilateral orchiectomy (removal of testes), synthetic luteinizing hormone-releasing hormone analogues.
Conditions that would present similarly
BPH
