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PHAM02 > Wk 13: Prostate cancer in practice > Flashcards

Wk 13: Prostate cancer in practice Flashcards

1
Q

What are the symptoms of prostate cancer?

A
  • Difficulty starting urination
  • Weak flow
  • Frequent urination
  • Difficulty emptying bladder
  • Burning when urinating
  • Pain: hips, back, chest + pelvis
  • Weak/numb legs
  • Erectile dysfunction
  • Painful ejacultion
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2
Q

What are the risk factors of prostate cancer?

A
  • Age
  • African/african caribbean
  • Fx - immediate who developed before 60
  • Obesity
  • Exercise
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3
Q

How is prostate cancer detected?

A
  • Digital rectal exam (DRE)
  • Prostate specific antigen test: higher = more likely
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4
Q

What is the PSA test?

A
  • Measures level of PSA in blood
  • PSA made by prostate
  • Prod by normal/cancerous cells
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5
Q

What is wrong with the PSA test?

A

Men w/ non-cancerous prostate enlargement also have elevated PSA levels

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6
Q

What is used to diagnose prostate cancer when the PSA/DRE is abnormal?

A
  • MRI scan
  • Transrectal ultrasound
  • Transperineal biopsy
  • Gleason score
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7
Q

What is the gleason score?

A
  • Determined when biopsy looked at under microscope
  • Looks at how likely cancer is to spread
  • 2-10
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8
Q

What is classed as low risk localised prostate cancer?

A
  • Slow growing tumour
  • PSA <10ng/ml
  • Gleason <7
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9
Q

What is classed as medium risk localised prostate cancer?

A
  • PSA 10-20ng/ml
  • Gleason 7
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10
Q

What is classed as high risk localised prostate cancer?

A
  • PSA >20ng/ml
  • Gleason: 8-10
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11
Q

What is the management for a low risk localised prostate cancer?

A
  • Active surveillance
  • PSA every 3-6 months
  • DRE every 6-12 months
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12
Q

What is the management for a medium/high risk localised prostate cancer?

A
  • Radical prostatectomy
  • Radical external beam radiotherapy
  • Radiotherapy + hormonal treatment
  • Brachytherapy (high risk: w/ external beam or hormonal)
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13
Q

What is external beam radiotherapy?

A
  • Destruction of cancer cells using focussed x-ray radiation from outside body
  • Used w/ hormonal therapy or after surgery
  • Painless
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14
Q

What are the short term effects of external beam radiotherapy?

A
  • Urinary problems – freq, urgency, retention
  • Bowel problems– di, wind, bleeding
  • Fatigue
  • Skin damage
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15
Q

What are the long term effects of external beam radiotherapy?

A
  • Ongoing urinary/bowel issues
  • Erectile dysfunction
  • Infertility
  • Lymphoedema
  • 2nd cancers
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16
Q

What is brachytherapy?

A
  • Delivers radiotherapy to prostate from internal source
  • Use: permanently implanted seeds or temp implanted wires directly into prostate
  • Requires: general/spinal anaesthetic
  • Antibiotics to prevent infection
17
Q

What is the treatment for locally advanced prostate cancer?

A
  • Radiotherapy
  • Hormonal treatment
  • Radical surgery discouraged
18
Q

What is used as first line for hormonal therapies?

A

LHRH agonist (goserelin + leuprorelin)

  • Tumour flare (10 days): anti-androgen tabs
  • 6 months during radical radiotherapy
  • Continue for 3 yrs in high risk/locally advanced cancers
19
Q

Which anti-androgen tablets are used for a tumour flare when using hormonal therapy?

A

Cyproterone

20
Q

What are the side effects of hormonal therapies?

A
  • Inc risk CVD
  • Hot flushes (medroxyprogesterone)
  • Osteoporosis (bisphosphonates/denosumab w/ calcium + vit D)
  • Lethargy (exercise)
21
Q

What is used to treat metastatic prostate cancer?

A

Combined androgen blockage

  • LHRH agonists inhibit testicular testosterone prod
  • Anti-androgen (cyproterone) blocks effect of remaining testosterone (prod from adrenal glands)
22
Q

What are the side effects of cyproterone?

A
  • Hot flushes
  • Sweats
  • Red libido
  • Gynaecomastia
23
Q

What is castration resistant prostate cancer?

A

Prostate cancer that keeps growing despite amount of testosterone in body is red to v low levels

24
Q

What is used to reduce the production of adrenal testosterone in castration resistant prostate cancer?

A

Corticosteroid

25
Q

What are the treatment options for castrate resistant metastatic prostate cancer?

A
  • Docetaxel - taxane
  • Cabazitaxel - taxane
  • Enzalutamide - androgen receptor antagonist
  • Abiraterone* - CYP450 inhibitor involved in androgen prod
  • Radium - bone seeking radioisotope
26
Q

What is bone metastasis?

A
  • Cancer cells activate osteoclast: weakens bone w/o new bone formation
  • Stims osteoblast: hardened areas of bones
27
Q

What is used for bone metastasis?

A
  • Bisphosphonates (zoledronic acid IV)
  • Symptom relief: strengthens bone + red pain
  • Treat hypercalcaemia
28
Q

What is malignant spinal cord compression?

A

Cancer cells grow in, near the spine + press on spinal cord + nerves

29
Q

What are the symptoms of malignant spinal cord compression?

A
  • Back pain
  • Motor dysfunction
  • Neurological symptoms
  • Bladder/bowel issues
30
Q

What is used to treat malignant spinal cord compression?

A
  • Dexamethasone 16mg stat
  • Monitor blood sugars
  • May use surgery/radiotherapy to decompress spine

PHAM02 (35 decks)

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