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Urinary System > Tumours of the Urinary System: Prostate Cancer > Flashcards

Tumours of the Urinary System: Prostate Cancer Flashcards

1
Q

Between what ages is prostate cancer most prevalent?

A

Between men ages 50 and 70yrs

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2
Q

What is the aetiology and risk factors for prostate cancer?

A

• 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

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3
Q

What are McNeal’s Prostatic Zones?

A
  • Transition zone
  • Central zone
  • Peripheral zone
  • Anterior fibromuscular stroma
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4
Q

Which of the McNeal’s prostatic zones if palpable?

A

Transition zone and is area where 80% of cancers develop and therefore can be palpable

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5
Q

How does prostate cancer present and how is it diagnosed?

A
  • Most asymptomatic
  • Diagnosed through opportunistic PSA testing
  • Diagnostic triad of PSA, DRE and TRUS-guided prostate biopsies
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6
Q

What are the presenting symptoms?

A 
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
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7
Q

What are the presenting symptoms of metastatic prostate cancer?

A 
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

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8
Q

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

A

Asymptomatic (i.e. incidentally noted)

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9
Q

Why is screening for prostate cancer not used?

A

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

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10
Q

What is used to avoid under-treatment of aggressive cancers (as screening not really used)?

A

Ad-hoc PSA testing

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11
Q

What is PSA?

A
  • 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)
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12
Q

What are the normal levels of PSA for different age groups?

A 
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
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13
Q

What are conditions with cause elevations in PSA?

A
  • UTI
  • Chronic prostatitis
  • Instrumentation (e.g. catheterisation)
  • Physiological (e.g. ejaculation)
  • Recent urological procedure
  • BPH
  • Prostate cancer
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14
Q

What grading system used to be used assess aggressiveness of a prostate tumour?

A

Gleason pathological grading system:
• Uses histological characteristics
• Grade 3-5

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15
Q

How do you work out the Gleason grading score?

A

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)

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16
Q

What is the new grading system used to grade prostate cancer?

A

ISUP grade (based on Gleason sum score

17
Q

Describe the different ISUP grade groups

A

ISUP Gleason
1: 3+3=6

2: 3+4=7
3: 4+3=7
4: 8
5: 9 and 10

18
Q

What are the different stages of prostate cancer?

A 
For purposes of treatment and prognosis, useful to divide prostate cancer into 4 stages (TNM):
• Localised stage
• Locally advanced stage
• Metastatic stage
• Hormone refractory stage
19
Q

What tests are used to stage localised prostate cancer?

A
  • Digital rectal examination (local staging)
  • PSA
  • Transrectal US guided biopsies
  • CT (regional and distant staging)
  • MRI (local staging)
20
Q

Describe T2 stage of prostate cancer

A

T2a: Tumour involves one-half of 1 side of the prostate.

T2b: Involves more than one-half of 1 side of the prostate but not both sides.

T2c: Tumour has grown into both sides of the prostate.

21
Q

Describe T3 stage of prostate cancer

A

Tumour has grown outside the prostate and might have spread to the seminal vesicles

22
Q

Describe T4 stage of prostate cancer

A

Spread into adjacent organs i.e. bladder, pubic bones

23
Q

What is the treatment for localised prostate cancer?

A

Watchful waiting
Radiotherapy:
• External-beam
• Brachytherapy

Radical prostatectomy:
• Open
• Laparoscopic
• Robotic

Others under investigation:
• Cryotherapy
• Thermotherapy

24
Q

What is the treatment of locally advanced prostate cancer?

A
  • Watchful waiting
  • Hormone therapy followed by surgery
  • Hormone therapy followed by radiation
  • Hormone therapy alone
  • Intermitted hormone therapy (clinical research)

Hormonal therapy lowers production of testosterone

25
Q

What are the different types of hormonal therapy for prostate cancer?

A
  • Surgical castration (i.e. bilateral orchidectomy)
  • Chemical castration (i.e. LHRH analogue)
  • Anti-androgens; inhibits androgen receptors
  • Oestrogens (i.e. diethylstilbestrol)
26
Q

What are the actions of oestrogens in hormonal therapy for prostate cancer?

A

Inhibits LHRH and testosterone secretion, inactivates androgens and has direct cytotoxic effect on prostatic epithelial cells

27
Q

What are the two types of chemical castration?

A

Chemical analogues works by negative feedback – Analogues initation increase levels causing tumour flare, but causes levels to increase so that pituitary stops producing LH

Chemical anatagonist works by prevents LH release from pituitary which stimulated release of testosterone from testes

28
Q

The following are reasonable treatment options for low-risk localised prostate cancer except:

a. External beam radiotherapy
b. Active surveillance
c. Brachytherapy
d. Radical prostatectomy
e. Radical chemotherapy

A

E

Radical = curative – chemo not curative and usually given neoadjuvant, radical neoadjuvant is hormonal therapy before radiotherapy

29
Q

The following statements about screening for prostate cancer are true except:

a. PSA is the best available screening test
b. Compared with ad-hoc opportunistic PSA testing, screening for prostate cancer is beneficial because it saves lives
c. If screening is advocated, it should be performed for men at risk of prostate cancer rather than the entire male population
d. Screening for prostate cancer is not currently advocated
e. For suspicious cases detected by screening, there is a need to undergo a definitive test to confirm or exclude presence of prostate cancer

Urinary System (31 decks)

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