Wk 13: Prostate cancer in practice Flashcards
What are the symptoms of prostate cancer?
- 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
What are the risk factors of prostate cancer?
- Age
- African/african caribbean
- Fx - immediate who developed before 60
- Obesity
- Exercise
How is prostate cancer detected?
- Digital rectal exam (DRE)
- Prostate specific antigen test: higher = more likely
What is the PSA test?
- Measures level of PSA in blood
- PSA made by prostate
- Prod by normal/cancerous cells
What is wrong with the PSA test?
Men w/ non-cancerous prostate enlargement also have elevated PSA levels
What is used to diagnose prostate cancer when the PSA/DRE is abnormal?
- MRI scan
- Transrectal ultrasound
- Transperineal biopsy
- Gleason score
What is the gleason score?
- Determined when biopsy looked at under microscope
- Looks at how likely cancer is to spread
- 2-10
What is classed as low risk localised prostate cancer?
- Slow growing tumour
- PSA <10ng/ml
- Gleason <7
What is classed as medium risk localised prostate cancer?
- PSA 10-20ng/ml
- Gleason 7
What is classed as high risk localised prostate cancer?
- PSA >20ng/ml
- Gleason: 8-10
What is the management for a low risk localised prostate cancer?
- Active surveillance
- PSA every 3-6 months
- DRE every 6-12 months
What is the management for a medium/high risk localised prostate cancer?
- Radical prostatectomy
- Radical external beam radiotherapy
- Radiotherapy + hormonal treatment
- Brachytherapy (high risk: w/ external beam or hormonal)
What is external beam radiotherapy?
- Destruction of cancer cells using focussed x-ray radiation from outside body
- Used w/ hormonal therapy or after surgery
- Painless
What are the short term effects of external beam radiotherapy?
- Urinary problems – freq, urgency, retention
- Bowel problems– di, wind, bleeding
- Fatigue
- Skin damage
What are the long term effects of external beam radiotherapy?
- Ongoing urinary/bowel issues
- Erectile dysfunction
- Infertility
- Lymphoedema
- 2nd cancers
What is brachytherapy?
- 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
What is the treatment for locally advanced prostate cancer?
- Radiotherapy
- Hormonal treatment
- Radical surgery discouraged
What is used as first line for hormonal therapies?
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
Which anti-androgen tablets are used for a tumour flare when using hormonal therapy?
Cyproterone
What are the side effects of hormonal therapies?
- Inc risk CVD
- Hot flushes (medroxyprogesterone)
- Osteoporosis (bisphosphonates/denosumab w/ calcium + vit D)
- Lethargy (exercise)
What is used to treat metastatic prostate cancer?
Combined androgen blockage
- LHRH agonists inhibit testicular testosterone prod
- Anti-androgen (cyproterone) blocks effect of remaining testosterone (prod from adrenal glands)
What are the side effects of cyproterone?
- Hot flushes
- Sweats
- Red libido
- Gynaecomastia
What is castration resistant prostate cancer?
Prostate cancer that keeps growing despite amount of testosterone in body is red to v low levels
What is used to reduce the production of adrenal testosterone in castration resistant prostate cancer?
Corticosteroid
What are the treatment options for castrate resistant metastatic prostate cancer?
- Docetaxel - taxane
- Cabazitaxel - taxane
- Enzalutamide - androgen receptor antagonist
- Abiraterone* - CYP450 inhibitor involved in androgen prod
- Radium - bone seeking radioisotope
What is bone metastasis?
- Cancer cells activate osteoclast: weakens bone w/o new bone formation
- Stims osteoblast: hardened areas of bones
What is used for bone metastasis?
- Bisphosphonates (zoledronic acid IV)
- Symptom relief: strengthens bone + red pain
- Treat hypercalcaemia
What is malignant spinal cord compression?
Cancer cells grow in, near the spine + press on spinal cord + nerves
What are the symptoms of malignant spinal cord compression?
- Back pain
- Motor dysfunction
- Neurological symptoms
- Bladder/bowel issues
What is used to treat malignant spinal cord compression?
- Dexamethasone 16mg stat
- Monitor blood sugars
- May use surgery/radiotherapy to decompress spine
