Week 4 Lectures Flashcards
What is the most common cause of PSA elevation?
BPH
Of all nodules felt on digital rectal exam, what percentage are cancer?
25%
Why would you do a Trans Rectal Ultrasound (TRUS)?
Only to help guide a prostate biopsy (or to help estimate size of prostate
When do you order a prostate biopsy?
BEST indication is a PSA velocity rising at 0.75/year or more
What are two characteristics of prostate cancer?
Multifocal and heterogenous (heterogeneity is unusual to this degree in a primary tumor–more common in metastasis)
What does prostate cancer’s heterogeneity and multifocal nature mean for treatment plans?
These two factors mean you can’t target a single area in prostate cancer for treatment–thus there is no focal treatment for prostate cancer
What is the most powerful prognostic tool for prostate cancer
Gleason score
What is the gleason score
Two numbers: A + B
A = most common cell type seen on slide
B = second most common
Add the two numbers together to get the Score
Score 1-6 = low risk (active surveillance)
Score 7 = intermediate risk
Score 8 and above = high risk
Score 7 and above requires treatment
60-70% of diagnosed prostate cancer is low risk
What does “high risk” prostate cancer mean?
Gleason score of 8 or above; higher risk of treatment failure, higher chance of metastasis, more aggressive
What areas of the prostate are of most concern for cancer (location)?
apex and base of prostate because these areas are close to the bladder and the urinary systems
What is the stage of the most common prostate cancers detected in men?
T1c (tumor found only on biopsy)
What are the treatment outcomes for localized prostate cancer? Metastatic?
Localized: treat to cure
Metastatic: non curable (fatal)
Why would you do surgery through perineum for prostate cancer?
Not done anymore except maybe for obese patients because less fat on the perineum so easier to reach
What is the most common radiation therapy for prostate cancer?
Brachytherapy
What radiation therapy would you use for more aggressive prostate cancers (gleason 8-9)? What about localized cancers?
Aggressive: External beam therapy (because dont want to miss any of the cancer)
Localized: Brachytherapy
What is active surveillance in prostate cancer treatment?
Periodic PSA, periodic rectal exams, periodic biopsies (to make sure there is no progression of the cancer) – 20-25% will progress
When would you use chemotherapy in prostate cancer?
only for patients with metastatic disease who have been treated with hormone therapy already but continue to have progressing diease
What chemo drug is used most often in prostate cancer?
Docetaxel
What drug is used before chemo in metastatic prostate cancer?
Abiraterone–a SIP 17 inhibitor
(used in castration resistant prostate cancer with metastasis before chemo)
–may also use Enzaltemide (androgen receptor antagonist)
What is the treatment for localized prostate cancer?
Surgery or radiation
What is the treatment for advanced prostate cancer?
Hormone therapy (and eventually chemo if unresponsive or continues progressing)
Most likely cause of painless hematuria
Neoplasm
Most likely cause of hematuria + renal colic
stones
Most likely cause of chills, fever, sepsis
infection