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PBL SEM 4 > overview of prostate cancer > Flashcards

overview of prostate cancer Flashcards

1
Q

describe the prostate gland

A
  • walnut-sized gland located behind the base of the penis, in - front of the rectum and below the bladder
  • surrounds the urethra
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2
Q

what is the primary function of the prostate gland?

A

produce seminal fluid, the liquid in semen that protects, supports, and helps transport sperm

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3
Q
A
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4
Q

what are risk factors for prostate cancer?

A
  • AGE
  • race (more common in african american men)
  • family history
  • nationality (more common in N America and NW Europe)
  • genetics (BRCA1+2 gene esp)
  • diet, exercise, obesity
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5
Q

1:___ men in the UK are diagnosied in the UK with prostate cancer

A

1:8

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6
Q

prostate cancer survival?

A

84% of men survive for 10 or more years (prostate cancer v prevalent but survival rates are good)

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7
Q

what are symtpoms of prostate cancer?

A

> local (LUTS = low urinary tract symptoms) — obstructive, irritative
metastatic — pain etc
systemic — fatigue, weight loss

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8
Q

describe some obstructive LUTS

A
  • feel as though not emptying bladder properly
  • terminal dribbling
  • get up to pee lots during the night
  • not good flow of urine
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9
Q

describe some irritative LUTS

A
  • a lot of urianry frequency
  • discomfort
  • possible blood in urine
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10
Q

how is prostate cancer diagnosed?

A
  • history
  • DRE = digital rectal exam
  • PSA = prostate specific antigen
  • multiparametric MRI
  • biopsy
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11
Q

what can increase PSA?

A
  • BPH = benign prostatic hypertrophy
  • age (increasing)
  • prostatitis
  • ejaculation
  • DRE
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12
Q

what can decrease PSA?

A
  • drugs — finasteride/dutasteride
  • obesity
  • herbal preparations
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13
Q

screening for prostate cancer

A
  • no UK screening programme
  • screening can lead to over diagnosis, over treatment
  • consider targeted PSA screening in high risk populations eg. African American, strong family history
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14
Q

describe multiparametric MRI

A

> T1 and t2 images
functional imaging
—> dynamic contrast enhanced (DCE) DWI
—> diffusion weighted imaging (DWI)

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15
Q

describe prostate biopsy

A

> transrectal ultrasound guided (TRUS) biopsy
—> biopsy taken throguh the rectal wall under ultrasound guidance
—> about 12 samples taken

> more recently, template biopsy
—> transperineal
—> multiple samples taken
—> can potential target areas seen on MRI that you cant reach via transrectal approach

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16
Q

reasons for doing a prostate biopsy

A
  • type of tumour
  • grade of tumour
  • percentage of tumour
  • T Stage of cancer
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17
Q

what type of tumour are the vast majority of prostate cancers?

A

adenocarcinoma

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18
Q

what is the grading score for tumour grade of prostate cancer?

A

gleason score

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19
Q

descirbe the gleason score

A
  • grading system used to define aggressiveness
  • score of 3-5 are considered cancerous
  • addition of 2 most common scores = Gleason score

2 scores out of 5 to give a score out of 10
lowest score can get it 3+3 (below is benign)
highest score is 5+5 = 10

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20
Q

descirbe grade group 1

A
  • gleason score 3+3
  • 96% 5 years RFS
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21
Q

describe grade group 2

A
  • gleason score 3+4 = 7
  • 88% 5 years RFS
22
Q

describe grade group 3

A
  • gleason score 4+3 = 7
  • 63% 5 years RFS
23
Q

describe grade group 4

A
  • gleason score 4+4 = 8
  • 48% 5 years RFS
24
Q

describe grade group 5

A
  • gleason score : 4+5=9, 5+4=9, 5+5=10
  • 26% 5 years RFS
25
Q

what does RFS stand for?

A

relapse free survival

26
Q

describe staging

A
  • a way of describing cacner — size and extent
  • TNM system
  • helps doctor to determine prognosis
  • formulation of treatment plan
27
Q

describe stage I prostate cancer

A
  • cancer confined to prostate T1a-2a
  • PSA < 10
  • grade group 1 (3+3 = 6)

confined to prostate, usually less than half of gland

28
Q

describe stage II prostate cancer

A

still localised to prostate

> stage IIA
-T1a-2a
- PSA 10-20
- grade group 2

> stage IIB
- T1-2
- PSA <20
- grade group 2

> stage IIC
- T1-2
- PSA <20
- grade group 3-4

29
Q

describe stage III prostate cancer

A

= locally advanced cancer

> stage IIIA
- T1-2
- PSA >20
- grade group 1-4

> stage IIIB
- T3-4
- grade group 1-4

> stage IIIC
- grade group

30
Q

describe stage IV prostate cancer

A

have spread outside of prostate locally (eg. pelvis) or beyond (liver, lungs, bones, pelvic lymph nodes etc)

31
Q

what are the most common places of spread of prostate cancer?

A

lymph nodes and the bones

32
Q

what are the 3 prognostic groups for localised prostate cancer

A
  1. low risk — T1-T2a and Gleason score 6 and PSA < 10ng/ml
  2. intermediate risk — T2b-T2c or Gleason score 7 or PSA 10-20
  3. high risk — T3a or Gleason score 8-10 or PSA >20
33
Q

treatment for low/intermediate risk disease

A

available for all treatment

  • active surveillance
  • external beam radiotherapy
  • brachytherapy
  • radical prostatectomy
34
Q

what might influence treatment choice?

A

> tumour factors — PSA, stage, grade
patient factors — age, LUTs, sexual function, choice, family or friends experience, media
pathway factors — urologists, nurses, support groups

35
Q

describe active surveillance

A
  • regular monitoring = PSA every 3 months, DRE 6 months, after a year repeat MRI and biopsy
  • PSA
  • DRE
  • mpMRI
  • biopsy

v. different to watchful waiting

36
Q

what is brachytherapy?

A

aka internal radiotherapy, close therapy

2 types

  • low dose rate = good for low or intermediate risk — implanting radioactive source into the prostate. under general anaesthetic, well tolerated, half life of 30 days
  • high dose rate = god for intermediate/high risk disease — used as mono therapy, or in combination wiht ERBT. radioactive source taken out
37
Q

describe external beam radiotherapy

A
  • OP treatment
  • 5-37 fractions (treatments) depending on risk
  • no anaesthetic
  • no catheter
  • often in combination with ADT
38
Q

describe surgery for prostate cancer

A

Robotic Assisted Laparoscopic Prostatectomy (RALP)

  • surgeon operates from a. console with a 3D screen
  • grasp controls to manipulate surgical tools within the patient
  • robotic arms translate finer, hand and wrist movements
  • very high-precision
39
Q

intermediate/high risk disease treatment

A
  • localised disease with higher risk of disease progression
  • important to adequately stage disease
  • radiotherapy + ADT
  • RALP with lymph node dissection
40
Q

what is ADT?

A

= androgen depravation therapy
- >95% newly diagnosed prostate cancer will respond to treatment with ADT
- 2 mechansims for preventing androgens :
—> reduce the level of androgens
—> block the androgens from binding

41
Q

describe reducing level of testosterone in ADT

A

injections : gonadotropin releasing hormone agonists (GnRHa) / Luteinising hormone releasing hornier agonists (LHRHa)

  • stimulate pituitary to produce LH
  • LH stimulates testicles to produce testosterone
  • chronic exposure to LHRH leads to desensitisation and a drop in LH —> subsequent drop in testosterone
  • may cause testosterone flare so need to give with androgen blocker
42
Q

what LHRH agonists are available?

A
  • Zoladex
  • Prostap — 4/54 or 12/52
  • Decapeptyl — 4/52, 12/52, 6/12
43
Q

describe GnRG/LGRG antagonists

A
  • prevent LHRH binding to pituitary gland — decrease LH — decrease testosterone
  • no testosterone flare
  • Degarelix — 240mg initial dose (2 x 120mg SC), 80mg 4/52
  • very expensive and has to be given every 4 weeks
  • only really used for men in hospital presenting with symptoms of disease such as malignant spinal cord compression
44
Q

describe androgen blockers

A
  • prevent testosterone from being able to stick to cell surface
  • often used for 3 or 4 weeks prior to and after LHRH agonist injections
  • used to reduce testosterone flare
  • Bicalutamide, Cyproterone Acetate
45
Q

ADT side effects

A

‘ male menopause ‘

46
Q

describe metastatic prostate cancer

A
  • disease has spread outside the prostate
  • not curable
  • aim of treatment = disease control
  • median survival is 5 years
  • hormone sensitive —> castrate resistant
  • ADT is backbone of treatment
47
Q

treatment for hormone sensitive metastatic prostate cancer

A
  • ADT always
  • chemotherapy — Docetaxel
  • novel hormones — Abiraterone, Apalutamide, Darolutamide, Enzalutamide
  • radiotherapy
48
Q

describe castrate resistant metastatic prostate cancer

A
  • 12-18 months post ADT initiation
  • rising PSA despite castrate levels of testosterone (<0.5mmol/L)
  • androgen receptor amplification
  • androgen receptor mutations
  • intraluminal androgen production
  • other growth signals take over
  • median survival - 3 years
49
Q

treatment for castrate resistant metastatic prostate cancer

A
  • ADT
  • supportive care — analgesia, antiemetics, psychological etc
  • chemotherapy — Docetaxel, Cabazitaxel
  • novel hormones — Abiraterone, Apalutamide, Darolutamide, Enzalutamide
  • radioisotopes — Radium 223, Lu-PSMA
  • radiotherapy — to painful bone metastases
50
Q

describe radium 223

A

similar to calcium

  • preferentially taken up into bones where the bones are working overtime — where cancer is active
  • Ra 223 then emits alpha particles — directly damage DNA

PBL SEM 4 (50 decks)

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