(U)- Prostate Cancer Flashcards
Where does prostate cancer most commonly spread to?
Lymph nodes
Bones
Mainly androgen-dependent to grow
Where do prostate cancers usually grow?
Majority are adenocarcinomas growing in the peripheral zone
What are the risk factors of prostate cancer?
Age
Family history
Black African or Caribbean origin
Tall
Anabolic steroids
How does prostate cancer present?
May be asymptomatic of with LUTS
- Hesitancy
- Frequency
- Weak flow
- Terminal dribbling
- Nocturia
May also have:
- Haematuria
- ED
- Cancer red flags
What is PSA?
Prostate-Specific Antigen
Epithelial cells of prostate produce this enzyme into semen and small amount into blood to thin the semen into liquid
Specific to the prostate only
What are the common causes of raised PSA?
Prostate cancer
BPH
Prostatitis
UTI
Vigorous exercise (especially cycling)
Recent ejaculation
What does a benign, inflamed/infected and cancerous prostate feel like?
Benign
- Smooth
- Symmetrical
- Soft
- Maintained central sulcus
Inflamed
- Enlarged
- Tender
- Warm
Cancerous
- Hard
- Asymmetrical
- Craggy or irregular
- Loss of central sulcus
- Hard nodules
What is the first-line investigation for suspected localised prostate cancer?
Multiparametric MRI
How are results from Multiparametric MRI reported?
Using Likert scale
1- Very low suspicion
2- Low suspicion
3- Equivocal
4- Probable cancer
5- Definite cancer
What is the next step in diagnosis after multiparametric MRI?
Prostate biopsy
Risk of false-negative if biopsy misses cancerous area, multiple samples needed, MRI to guide best target
How is prostate biopsy carried out?
Transrectal ultrasound-guided biopsy
Transperineal biopsy
- Needle inserted through perineum under local anaesthetic
What are the risks of prostate biopsy?
Pain
Bleeding
Infection
Urinary retention (due to short-term swelling of prostate)
ED
What is an isotope bone scan used for?
Look for bony metastasis
Radioactive isotope given by IV, 2-3 hour wait
Gamma camera takes pictures of skeleton
What is the Gleason Grading System?
Based on histology from biopsies
Specific to prostate cancer
Greater the score the more poorly differentiated the tumour
1-normal
5-abnormal
Made of two numbers
First number grade of most prevalent pattern
Second number, second most prevalent pattern
6-Low risk
7-Intermeiate risk
8-High risk
How is prostate cancer managed?
MDT guided
- Surveillance
- External beam radiotherapy
- Brachytherapy
- Hormone therapy
- Surgery