Vicki L3 - Prostate Flashcards
Prostate cancer is the ____ common cancer in men. Men have a __% lifetime risk of developing but only __% have clinically significant PC. Many have it but have no ____ and often just die of old age or something else.
Most
30%
10%
Symptoms
Risk factors:
- ___ = strongest risk factor
- Race = low incidence in ___ ____
- Genetics - 2/3 fold increase if __ ____ relative affected
- Androgens - rare in males castrated b4 puberty (______ plays a role)
- Protective factors = freq ____ and diet high in ______ (tomatoes)
Age Far east 1st degree Testosterone Ejaculation Lycopenes
Pathology and staging:
- Prostates normal function is to produce the ___ part of ____.
- It is an _______ and can metastasise to the _____.
- Grading is based on the ___ or ____ system.
Lower score =
____ differentiated
% likelihood progression by 10 yrs around 25%
% likelihood death by 15 yrs around 8%
Higher score =
_____ differentiated
% likelihood progression by 10 years around 70%
% likelihood death by 15 yrs around 65%
Fluid part of semen
Adenocarcinoma and can metastasise to the bones
TNM (tumour, nodes, metastases)
Gleason system
Well
Poorly
Clinical presentation:
- Lower urinary tract symptoms caused by localised prostate cancer (similar to symptoms caused by ___)
- 5 symptoms - what are they?
BPH
- Increased frequency
- Hesitancy
- Post micturition dribbling
- Nocturia
- Reduced void pressure
1/3 of patients present with symptoms from locally invasive or metastatic disease:
Locally invasive disease symptoms due to invasion of neural structures e.g ____ base and _____ tissues:
(4) symptoms - what are they?
Bladder base and perirectal tissues:
- impotence
- haematospermia
- perineal pain (adjacent to anus)
- incontinence
Metastatic symptoms result from ___ and ____ ____ involvement and have an effect on related structures: 6 symptoms. What are they?
Bone and Lymph node
- Bone pain
- Hypercalcaemia
- Spinal cord compression
- Sciatica/paraplegia
- Fracture
- Lymphoedema
Diagnosis:
1) ____ ____ examination - info on ___ of prostate, ____, ____.
Cannot detect T1 disease (nodules too small to feel) - can feel bigger ones though. The test is limited as the accuracy depends on the _____. Could also be ___.
2) ___ - prostate ____ _____. A glycoprotein secreted by prostatic cells to aid ______ of semen. Leaks through cancer cells membrane into circulation. ____ of over 50% is associated with ____ metastases.
Up to 20% of men with PC don’t have raised ___ levels and it also increases with ___ in general and benign prostate enlargement. Despite this, levels are still measured to monitor pts ____ and ___ therapy to assess response.
Digital rectal examination
Size of prostate, nodules and firmness
Examiner
BPH
PSA (prostate specific antigen)
Liquidification
PSA
Bony
PSA
Age
before
after
Diagnosis of PC:
1) ______ ultrasound (TRUS) - more accurate than PR exam for staging PC but overall cancer detection is low. An ______ probe is inserted into the ____ to image prostate and usually a ____ is performed at the same time
2) CT/___ scan - to identify _____ disease
3) _______ bone scanning - sensitive and specific way of detecting bony mets
Transurethral
Ultrasound
Rectum
Biopsy
CT/MRI scan to identify metastatic
Radiolabelled
4) Brachytherapy
Delivers _____ through implantation of needles containing radioactive pellets into ______ gland.
The pellets are usually left in _____ and emit low dose _____ over several weeks/months. Used at primary therapy in combination with radiotherapy or ______ deprivation therapy. Conducted under general/spinal anaesthesia. Efficacy and long term side effects similar to surgery/radiotherapy.
Radiation Prostate Permanently Radiation Androgen
5) Hormonal therapies
In locally advanced and metastatic PC. Can combine with ______ and radical prostatectomy in locally advanced disease.
Rapid response but duration only really lasts _ years. Hormone therapies block _____ that drive and sustain most PCs. Androgens consists mainly of _____ produced in the testes. 10% androgens are produced in the _____ _____. _____ and other androgens metabolised at cellular level to dihydro______ (DHT) which is an active metabolite. It is also the target for some of these treatments.
Radiotherapy 2 years Androgens Testosterone Adrenal gland Testosterone dihydrotestosterone
Production of androgens:
1) ______ = produced by testes and is in circulation
2) production is under control of __ released from pituitary gland
3) __ is under control of ____ released from hypothalamus
4) ____ released in pulsatile manner and ____Rs are desensitised if constant stimulation
5) Desensitisation is exploited in treatments
Testosterone LH LH LHRH LHRH LHRHRs
Hormonal therapies:
____ blockade is achieved in several ways.
1) Bilateral ________ = remove both ____ to stop _____ secretion
2) LHRH analogues (g____, t______) monthly/3 monthly sc depot injections. Disrupt normal pulsatile release of LHRH. The receptors think there’s loads of LHRH so increase __ production causing receptors to ______ resulting in decreased __ and _______ action. The initial increase in __ can cause transient increase in tumour size (_____) and worsen symptoms so an androgen blocker is often given for the first few ____ e.g. b_______
Androgen Orchiectomy Testicles Testosterone Goserelin and triptorelin LH desensitise LH Testosterone LH flare Bicalutamide
Androgen blockers e.g. ______ and cyproterone. Compete with ___ at receptor level within PC cells. Give for a few _____.
Bicalutamide
DHT
Weeks
Maximal androgen blockade. Combination of ____ analogue e.g. ______ and anti androgen e.g. ______.
LHRH
Goserlein
Bicalutamide
Intermittent hormone therapy: Treat with ____ analogue but withdrawal of this may allow growth of hormone sensitive cells in tumour which can be treated again as ___/_____ dictate. So give an injection and ___ levels should decrease then wait for ____ levels to increase again and then repeat. So treat in _____.
LHRH PSA/symptoms PSA PSA Cycles
