(U)- Prostate Cancer Flashcards

1
Q

Where does prostate cancer most commonly spread to?

A

Lymph nodes
Bones

Mainly androgen-dependent to grow

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2
Q

Where do prostate cancers usually grow?

A

Majority are adenocarcinomas growing in the peripheral zone

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3
Q

What are the risk factors of prostate cancer?

A

Age
Family history
Black African or Caribbean origin
Tall
Anabolic steroids

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4
Q

How does prostate cancer present?

A

May be asymptomatic of with LUTS

  • Hesitancy
  • Frequency
  • Weak flow
  • Terminal dribbling
  • Nocturia

May also have:
- Haematuria
- ED
- Cancer red flags

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5
Q

What is PSA?

A

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

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6
Q

What are the common causes of raised PSA?

A

Prostate cancer
BPH
Prostatitis
UTI
Vigorous exercise (especially cycling)
Recent ejaculation

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7
Q

What does a benign, inflamed/infected and cancerous prostate feel like?

A

Benign
- Smooth
- Symmetrical
- Soft
- Maintained central sulcus

Inflamed
- Enlarged
- Tender
- Warm

Cancerous
- Hard
- Asymmetrical
- Craggy or irregular
- Loss of central sulcus
- Hard nodules

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8
Q

What is the first-line investigation for suspected localised prostate cancer?

A

Multiparametric MRI

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9
Q

How are results from Multiparametric MRI reported?

A

Using Likert scale

1- Very low suspicion
2- Low suspicion
3- Equivocal
4- Probable cancer
5- Definite cancer

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10
Q

What is the next step in diagnosis after multiparametric MRI?

A

Prostate biopsy

Risk of false-negative if biopsy misses cancerous area, multiple samples needed, MRI to guide best target

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11
Q

How is prostate biopsy carried out?

A

Transrectal ultrasound-guided biopsy

Transperineal biopsy
- Needle inserted through perineum under local anaesthetic

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12
Q

What are the risks of prostate biopsy?

A

Pain
Bleeding
Infection
Urinary retention (due to short-term swelling of prostate)
ED

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13
Q

What is an isotope bone scan used for?

A

Look for bony metastasis

Radioactive isotope given by IV, 2-3 hour wait

Gamma camera takes pictures of skeleton

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14
Q

What is the Gleason Grading System?

A

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

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15
Q

How is prostate cancer managed?

A

MDT guided

  • Surveillance
  • External beam radiotherapy
  • Brachytherapy
  • Hormone therapy
  • Surgery
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16
Q

What is a key complication of external beam radiotherapy?

A

Proctitis

Inflammation in the rectum due to radiation

  • Pain
  • Altered bowel habit
  • Rectal bleeding
  • Discharge

Prednisolone suppositories help reduce inflammation

17
Q

What is brachytherapy?

A

Implanting radioactive metal seeds into prostate

Delivers continuous, targeted radiotherapy to prostate

Can cause:
- Cystitis
- Proctitis
- ED
- Incontinence
- Increased bladder and rectal cancer risk

18
Q

What does hormone therapy in prostate cancer involve?

A

Aim to reduce androgen level in combination with radiotherapy or alone in advanced disease when you cannot cure

  • Androgen-receptor blockers (bicalutamide)
  • GnRH agonists (goserelin)
  • Bilateral orchidectomy

Can cause:
- Hot flushes
- Sexual dysfunction
- Gynaecomastia
- Fatigue
- Osteoporosis

19
Q

How can prostate cancer be treated if it is confined to the prostate?

A

Radical prostatectomy

Can cause:
- ED
- Urinary incontinence