Urology: Prostate Cancer Flashcards
Adenocarcinoma of the prostate most commonly found in which part of the prostate? [1]
Peripheral prostate
Signs and symptoms of:
Early stage prostate cancer? [6]
Late stage prostate cancer? [3]
Early stage:
* Often asymptomatic
* Urinary frequency
* Poor flow
* Nocturia
* Dribbling
* Renal obstruction
* Haematuria / Haematospermia
* Nodular hard craggy prostate on DRE
If metastised:
* Weight loss
* Bone pain
* Anaemia
What investigations should you conduct for prostate cancer:
- Indication of cancer? [2]
- For diagnosis? [2]
- For staging? [1]
- To investigate metastasis? [1]
PSA (raised) & hard, irregular DRE: indicates cancer
Multiparametric MRI is now commonly the first line investigation in the diagnosis of prostate cancer.
Transrectal US & biopsy: for diagnosis
Bone scan: for metastasis
CT: for staging
Describe the two forms of prostate biospy [2]
There are two options for prostate biopsy:
Transrectal ultrasound-guided biopsy (TRUS):
- ultrasound probe inserted into the rectum, providing a good indicate of the size and shape of the prostate. Guided biopsies are taken through the wall of the rectum, into the prostate.
Transperineal biopsy
- involves needles inserted through the perineum. It is usually under local anaesthetic.
A guided biopsy is offered to patients with a Likert score of [] or greater
A guided biopsy is offered to patients with a Likert score of 3 or greater
3 = Chance of clinically significant cancer is equivocal
4 = Clinically significant cancer is likely to be present
5 = Clinically significant cancer is highly likely to be present
State 5 non-cancerous causes of PSA increase [6]
benign prostatic hypertrophy (BPH)
prostatitis
digital rectal examination (DRE)
urethral catheterisation
urinary tract infection (UTI)
prostatic biopsy
Vigorous exercise (notably cycling)
Recent ejaculation or prostate stimulation
What levels normal PSA? [1]
What is the upper limit of normal PSA:
- under age of 50 [1]
- over the age of 70 [1]
Normal range varies w/ age, but generally < 4 ng/ml
Upper limit of normal PSA:
< 2.7 ng/ml if under 50;
< 7.2 over 70
How does prostatic cancer appear in T2 MRI? [1]
What radiological score do you use from MRI imaging to score prostatic cancer? [1]
T2 MRI:
- Tumour is dark; lighter area is healthy
PIRADS Score (1-5; low cancer - 5 is high)
Name this form of prostate biopsy [1]
Trans-rectal ultrasound: OUT OF USE due to high infection rate and limited number of biopsies able to take
Name this form of taking prostate biopsies [1]
Why is it better than trans rectal biopsy? [1]
Template / transperineal biopsy (BP)
Less infections; more biopsies can be taken
Which histological scoring system is used to grade prostate cancers? [1]
Describe how you use this scoring system [2]
Gleason score [1-5]
Because prostate cancers are heterogenous; Gleason score is a score made from:
The first number is the grade of the most prevalent pattern in the biopsy
The second number is the grade of the second most prevalent pattern in the biopsy
In prostate cancer, what classification system is used for staging? [1]
In prostate cancer, what classification system is used for histological grade? [1]
In prostate cancer the TNM classification is used for staging whilst the Gleason score gives the histological grade
What are well, moderately and poorly differentiated Gleason scores? [3]
Well differentiated: Score 2-4
Moderately differentiated: Score 5-7
Poorly differentiated: Score 8-10
Multiparametric MRI of the prostate is now the usual first-line investigation for suspected localised prostate cancer. The results are reported on a [] scale.
Describe the differences in results given from this scale. [5]
The results are reported on a Likert / PIRADS scale
1 – very low suspicion
2 – low suspicion
3 – equivocal
4 – probable cancer
5 – definite cancer
Name two differentials for prostate cancer [2]
How would you investigate to differentiate between them and prostate cancer? [3]
BPH: positive prostate biopsy
Chronic prostatitis: leukocytes
indicative of inflammation
What is an aide for memorising upper age limit of PSA levels? [1]
(Age-20) / 10
