Urology - prostate cancer Flashcards
Common metastasis sites for prostate cancer
Lymph nodes
Bones
What are most prostate cancers?
Prostate cancer is almost always androgen-dependent, meaning they rely on androgen hormones (e.g., testosterone) to grow.
Most commonly they are adenocarcinomas
Risk factors for prostate cancer
Increasing age Family history Black African or Caribbean origin Tall stature Anabolic steroids
Presentation of prostate cancer
Asymptomatic
LUTS - hesitancy, frequency, weak flow, terminal dribbling and nocturia.
Haematuria
Erectile dysfunction
Symptoms of advanced disease or metastasis e.g. weight loss, bone pain or CES
Examination to do if suspect prostate cancer
DRE
Management of prostate cancer
2 WW referral
Multiparametric MRI - usual first-line investigation for suspected localised prostate cancer
Prostate biopsy is the next step depending on MRI findings and clinical suspicion
What are the two options for prostate biopsy?
Transrectal ultrasound-guided biopsy (TRUS)
Transperineal biopsy - needle through the perineum - under local anaesthetic
Risks of prostate biopsy
Pain (particularly lower abdominal, rectal or perineal pain)
Bleeding (blood in the stools, urine or semen)
Infection
Urinary retention due to short term swelling of the prostate
Erectile dysfunction (rare)
Other scan that can consider doing in prostate cancer?
An isotope bone scan (also called a radionuclide scan or bone scintigraphy) can be used to look for bony metastasis.
What staging systems can be used for prostate Ca?
Gleason grading system - score of 8 or above is high risk (the higher the score, the more poorly differentiated the tumour is - the cells have mutated further from normal prostate tissue)
TNM staging
T part of TNM staging breakdown of score
TX – unable to assess size T1 – too small to be felt on examination or seen on scans T2 – contained within the prostate T3 – extends out of the prostate T4 – spread to nearby organs
N part of TNM staging breakdown of score
NX – unable to assess nodes
N0 – no nodal spread
N1 – spread to lymph nodes
M part of TNM staging breakdown of score
M0 – no metastasis
M1 – metastasis
Management options in prostate cancer
Hormonal therapy
Radiotherapy - external beam or brachytherapy
Surgical options e.g. radical prostatectomy
- or bilateral orchidectomy - can be used but rarely (lowers androgen levels rapidly)
Hormone therapy options
GnRH agonists e.g. goserelin
Androgen-receptor blockers such as bicalutamide
The aim of hormone therapy is to reduce levels of androgens as these stimulate growth of the cancer
