Wk 6 Prostate Cancer Flashcards
4 risk factors for prostate cancer
- Age: 90% are in men over age 50 - strongest risk factor
- Family Hx
- Race - more common in African-American men
- BCRA mutation carriers
What is PSA
=prostate specific antigen
- a glycoprotein (KLK3) expressed by normal and neoplastic prostate tissue
- fxns as a serine protease to: 1. liquify semen 2. dissolve cervical mucus
- exists in serum in free and bound forms, so total = free PSA + complexed PSA
- can be elevated by a number of things, want to look a changes over time
What can lead to elevated PSA
- protatitis
- prostate exam
- prostate biopsy
What determine prognosis of cancer?
- PSA level
- clinical stage (digital rectal exam)
- biopsy (Gleason score)
What determines if tx will happen with prostate cancer?
NCCN PCa risk stratification
How is localized prostate cancer treated?
Curative:
1. radical prostatectomy
2. radiation therapy (similar outcomes)
OR
3. active surveillance
Side effects of prostate Ca tx (surgery and/or radiation)
- urinary incontinence
- erectile dysfunction
Where is BPH often seen in the prostate?
middle of prostate
Clinical presentation of BPH
urinary retetion
UTI
Clinical presentation of BPH
urinary retetion
UTI
TX of BPH
TERP - cut out tissue to widen urethra
How do BPH and prostate cancer compare histologically?
Lower right = cancer - crowded, no basal cell layer (only single cell lining), enlarged nuclei, clonal, losing polarity (moving away from basal layer)
What is Gleason’s Pattern?
A way to score the cancer
-add 2 scores of highest proportions
-indicates how aggressive the cancer is
What does inasive indicate?
The cancer has spread to the submucosa
What does inasive indicate?
The cancer has spread to the submucosa
How do NSAIDs influence adenoma development?
Inhibit COX and therefore prostaglandins
Adenoma
precursor and potential for cancer
Adenoma
precursor and potential for cancer
Sessile serrated adenoma
Tubular adenoma
low grade dysplasia
surface epithelium
invasive adenocarcinoma
Juvenile polyposis syndrome
JPS
-at risk for colon cancer, gastric and small intestine adenocarcinoma
Genetics of juvenile polyposis syndrome
autosomal dominant
-SMAD4 mutation
Cancer potential w/ juvenile polyps
Only JPS has potential for cancer
sporadic juvenile polyps do not
Peutz-Jeghers poylps
-marker for increased risk of cancer in colon, breast, stomach, sm intestine and more
Peutz-Jeghers Syndrome
PTEN hamartoma-tumor syndrome
autosomal dominant
-mutation in PTEN TS gene
-high risk of melanoma, thyroid, breast, colon cancers
-trichilemmomas (small bumps on nose)
-lipomas
-macrocephaly
-freckling on penis
Cronkhite-Canada syndrome
-unknown cause
-hamartomatous polyps
-nail atrophy, alopecia, skin hyperpigmentation, diarrhea, cachexia, anemia
-in intervening tissue as well
-rare, fatal in 50%
Tuberous Sclerosis
mutations in TSC1 and TSC2
-presents soon after birth
-epilepsy, cortical tubers, astrocytomas
-cortical tubers
