Renal & Urology / Prostate Cancer Flashcards
What cancer is the most common cancer in men and the second leading cause of cancer death in men?
Prostate cancer (CaP)
What are the risk factors for CaP?
- advanced age
- positive family history
- African American ethnicity
- high dietary fat intake
How does CaP present?
- Early disease may be asymptomatic but detectable by screening.
- Urinary obstruction symptoms, erectile dysfunction, and hematospermia are uncommon but more typical in advance disease.
What are the screening methods for CaP?
- Digital rectal exam (DRE) and prostate specific antigen (PSA)
What DRE findings would suggest malignancy?
Hard and irregular nodules, usually in the peripheral zone (70%)
Besides CaP, what can cause a PSA elevation?
- Benign prostatic hyperplasia
- acute prostatitis
- prostate massage
- prostate biopsy
- ejaculation
- digital rectal examination
- perineal trauma
What is the cutoff for identifying an elevated PSA that has been used in screening studies?
4 ng/mL
What is the sensitivity and specificity of using this cutoff to identify CaP?
- Sensitivity of 70%-80%
- specificity of 60%-70%
What are the potential harms from PSA screening?
- additional medical visits
- adverse effects of prostate biopsies
- anxiety
- overdiagnosis (identifying prostate cancer that would never have caused symptoms during the patient’s lifetime)
Have any high quality randomized controlled trials demonstrated that PSA screening decreases morbidity or mortality?
No.
- A Cochrane meta-analysis found no difference in CaP mortality between men invited to CaP screening and control groups.
- According to the USPSTF, there is insufficient data to determine whether PSA screening decreases morbidity or mortality.
How is a definitive diagnosis of CaP made?
- Biopsy (ultrasound guided)
After lymph nodes, what is the most common site of CaP metastasis?
Bone
What is the most common symptom of bone metastasis?
Pain
