Urology: Prostatic Cancer Flashcards
what can be found superior to the prostate?
neck of the bladder
what can be found inferior to the prostate?
external urethral sphincter
which muscle can be found inferlaterally to the gland?
levator ani
what can be found posterior to the gland?
ampulla of the rectum
what does the prostate secrete?
proteinlytic enzymes
where do the prostatic ducts open?
prostatic portion of the urethra on each side of the seminal colliculus
3 zones of the prostate
- central zone
- transitional zone
- peripheral zone
what happens at the central zone?
- it surrounds the ejaculatory ducts
- the ducts of the glands from the zone empty obliquely into the prostatic urethra
what happens at the transitional zone?
- surrounds the urethra
- these are the glands that traditionally are involved in BPH
what happens at the peripheral zone?
- ducts from this area empty vertically which can permit urine reflux
- this is the zone that can be felt in a DRE
what is the fibromuscular stroma?
- situated anteriorly in the gland
- merges with the tissue of the urogenital diaphragm
how is the prostate vascularised?
- prostatic arteries (from the internal iliac arteries)
- prostatic venous plexus, draining into the internal iliac vein
how is the prostate innervated?
the inferior hypogastric plexus supplies sympathetic, parasympathetic and sensory innervation
- the smooth muscle is innervated by the sympathetic fibres
why are the neighbouring neurovascular bundles important?
- these go to the penis, to supply blood and innervation to the corpora cavernose, which are important for a normal erection
- these might be damaged during radical prostatectomy
what is the most common type of prostate cancer?
adenocarcinoma
risk factors for prostate cancer
- age
- family history
- ethnicity
how can prostate cancer spread?
- local
- lymph
- haematogenous
symptoms of prostate cancer
- mainly asymptomatic
- urinary frequency
- low flow
- urgency
- haematuria
- obstructive symptoms, irritative symptoms, bleeding and haematospermia
- uraemia
- advanced disease: anaemia, bone pain, renal failure, weight loss, anorexia
causes of high PSA
- old age
- BPH
- prostate CA
- prostatitis
- instrumentation
- acute urinary retention
- prostatic stimulation
investigations of prostate cancer
- PSA assays
- CBC
- creatinine
- LFTs (alkaline phosphate)
- transrectal ultrasound
- MRI prostate to stage and detect the cancer
- CT abdo
- bone scan
- LN staging at surgery
- MRI/US fusion biopsy
what staging classification do you use?
TNM classification and Gleason score
what can determine and contribute to prognosis?
- tumour stage
- Gleason grade
- PSA at diagnosis
- tumour volume
- capsular penetration, seminal vesicle invasion or margin positivity at the time of prostatectomy
- patient factors also important - age, co-morbidity
treatment options for prostate cancer
- active surveillance (monitor PSA)
- external beam radiotherapy
- radical prostatectomy
- depends on your age (younger patients will get more aggressive treatment)
- brachytherapy (seeds of radiotherapy implanted into the prostate)
- hormonal therapy (block testosterone production)
what should you do after treatment
continue monitoring the PSA level
treatment options for relapsed cancer
- salvage radiotherapy
- salvage radical prostatectomy
- hormonal therapy
treatment options for advanced disease
- hormonal manipulation
- medical/surgical castration - subcapsular orchidectomy, LHRH agonists, LHRH antagonists
- testoterone flare - cover with anti-androgens
causes of an increased PSA level
- infection
- instrumentation
- benign and malignant prostate condition
how does contrast interact with prostatic cells?
cancer cells are packed in a tighter way which result in less diffusion and pools at a certain area
complications of external beam radiotherapy
- urinary side effects (frequency, urgency)
- rectal side effects (diarrhoea, pain on defaecation, rectal bleeding)
which blood test is a good predictor for bone metastasis
PSA (>20 more likely to have metastasis)
types of hormonal therapy
- androgen ablation (surgical/medical castration)
- anti-androgen
- oestrogen
