The Big 4 - Prostate Flashcards
How common is prostate cancer?
-13 in 100 men
-50% occur in >75 y/os
-FH and afro-carribbean ethnicity are RFs
What are the histological types of prostate cancer?
->95% are adenocarcinomas developing in glandular tissue
-Arises in posterior or peripheral parts of prostate, BPPH commonly develops in the centre
How does prostate cancer normally present?
-Can be asymptomatic and be found on DRE / PSA testing
-Can present with LUTS ie poor stream, nocturia, dribbling, increased frequency, impotence
-1 in 5 present with metastatic prostate cancer with eg anaemia, pain, pathological fracture, SCC
-Enlarged, hard, craggy gland with obliteration of the median sulcus on DRE
What investigations would someone with suspected prostate cancer have?
-Initially, DRE + PSA (<4.0 ng/mL is normal)
-MRI to delineate any eta-capsular spread in patients fit for surgery
-Isotope bone scan to detect bone involvement
-TRUS-guided biopsy to confirm diagnosis but not if clinical suspicion is high
What does the T0-4 denote in prostate cancer?
T0 = no evidence of primary tumour
T1 = clinically unapparent tumour not palpable nor visible by imaging
T2 = tumour confined within prostate
T3 = tumour extends through the prostate capsule
T3a = extra capsular extension
T3b = tumour invades seminal vesicles
T4 = tumour is fixed / invades adjacent structures
What does the M1a-c staging denote in prostate cancer?
M1 = distant mets
M1a = non-regional lymph nodes
M1b = bones
M1c = other / multiple sites
What grading system is used in prostate cancer?
Gleason system scores from 6-10
(pathologists grade different samples a score between 3+5, and add these scores together to get Gleason score)
eg Gleason score 6 = 3+3 (Grade Group 1)
Gleason score 9 = 4+5 (Grade Group 5)
How would you manage asymptomatic patients with disease confined to the prostate?
Observation is often most appropriate, especially if elderly / with other comorbidities that are more likely to limit the patient’s life than the cancer
How would you surgically manage a patient with prostate cancer?
-Patients with localised (T2 or less) disease
-Radical prostatectomy with curative intent
-Robotic laparoscopy has improved outcomes
-Trans-urethral resections may be used palliatively to relieve symptoms or obstruction
How is radiotherapy used to treat prostate cancer?
-RADICAL - alternative to surgery in T1/2 tumours + control of advanced local disease
-ADJUVANT - following radical surgery if concern for residual disease (delay for 6/52 to prevent stricture formation)
-PALLIATIVE - for primary tumour or for metastatic complications eg bone pain
How is RT delivered in prostate cancer and what are the side effects?
-External beam irradiation or brachytherapy (interstitial implantation of radioisotopes, done surgically)
-SEs = dysuria, rectal bleeding, diarrhoea, impotence, incontinence
What hormone therapy is used to treat prostate cancer?
-Used for advanced disease or with RT for local disease
-Inhibition of the growth-stimulatory effect of endogenous androgens has 80% response rate
-Options:
–LHRH agonists (eg leuprorelin, goserelin) - reduces testosterone levels
–Gonadotrophin-releasing hormone antagonist (degarelix) - reduces testosterone levels
–Oestrogen therapy - inhibits LHRH production
–Anti-androgens (eg bicalutamide, enzalutamide)
–Bilateral orchidectomy
How is chemotherapy used to treat prostate cancer?
-Docetaxel (+ prednisolone) and cabazitaxel is can treat metastatic disease
What is the prognosis for prostate cancer?
-Low risk localised disease = 99% 10YSR regardless of treatment
-Average = 84% 10YSR
-Metastatic disease = 3.5 yrs
How common is it to have an abnormally high PSA?
NB high = >3ng/ml
-83/100 will have a normal PSA (15% of these will be a false negative)
-17/100 will have a high PSA (2ww, MRI, biopsy) and only 25% of these will have cancer
