Tumours of the Urinary System: Prostate Cancer Flashcards
Between what ages is prostate cancer most prevalent?
Between men ages 50 and 70yrs
What is the aetiology and risk factors for prostate cancer?
• Age
• Race/Ethnicity: African or Afro-Caribbean men living in Western countries
• Geography: Northwest Europe/North America/Caribbean/ Australia
• Family history
- first degree relative 2x risk
- HPC1; BRCA1 & 2
What are McNeal’s Prostatic Zones?
- Transition zone
- Central zone
- Peripheral zone
- Anterior fibromuscular stroma
Which of the McNeal’s prostatic zones if palpable?
Transition zone and is area where 80% of cancers develop and therefore can be palpable
How does prostate cancer present and how is it diagnosed?
- Most asymptomatic
- Diagnosed through opportunistic PSA testing
- Diagnostic triad of PSA, DRE and TRUS-guided prostate biopsies
What are the presenting symptoms?
Locally invasive disease (not local disease) • Haematuria • Perineal and suprapubic pain • Impotence • Incontinence • Loin pain or anuria (obstruction of ureters) • Symptoms of renal failure • Haemospermia • Rectal symptoms including tenesmus
What are the presenting symptoms of metastatic prostate cancer?
Distant mets: • Bone pain or sciatica • Paraplegia (spinal cord compression) • Lymph node enlargement • Lymphoedema • Loin pain or anuria (ureter obstruction by lymph nodes)
Widespread mets:
• Lethargy (i.e. anaemia, uraemia)
• Weight loss and cachexia
What is the commonest mode of presentation for prostate cancer?
a. Frank haematuria
b. Asymptomatic (i.e. incidentally noted)
c. Acute urinary retention
d. Symptoms of benign prostatic enlargement and obstruction
e. Bone pain
Asymptomatic (i.e. incidentally noted)
Why is screening for prostate cancer not used?
Most cancers picked up by screening usually in very early stages -> leads to over-diagnosis and over-treatment
Targeted people useful to carry out PSA screening
What is used to avoid under-treatment of aggressive cancers (as screening not really used)?
Ad-hoc PSA testing
What is PSA?
- Kallikrein serine protease - liquifies semen
- Produced by glands of prostate - may leak into serum
- Normal serum range 0-4.0 ug/mL
- Half life in 2.2 days (repeat tests taken after 3 weeks)
What are the normal levels of PSA for different age groups?
Age-related range - Levels increase with age: • < 50 years : 2.5 is upper limit • 50-60 years : 3.5 is upper limit • 60-70 years : 4.5 is upper limit • >70 years : 6.5 is upper limit
What are conditions with cause elevations in PSA?
- UTI
- Chronic prostatitis
- Instrumentation (e.g. catheterisation)
- Physiological (e.g. ejaculation)
- Recent urological procedure
- BPH
- Prostate cancer
What grading system used to be used assess aggressiveness of a prostate tumour?
Gleason pathological grading system:
• Uses histological characteristics
• Grade 3-5
How do you work out the Gleason grading score?
The first number assigned is the grade that is most common in the tumour.
For example, if the Gleason score is written as 3+4=7, it means most of the tumour is grade 3 and less is grade 4, and they are added for a Gleason score of 7.
Highest score is 10 (as grade is from 3-5)