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Urogenital Y2 > L18 - Prostate cancer > Flashcards

L18 - Prostate cancer Flashcards

1. Describe the common presentations (both anatomical and physiological) of prostate cancer with reference to the role of prostate specific antigen PSA 2. Explain the importance of prostate specific antigen PSA in diagnosis of prostate cancer 3. Natural history of prostate cancer, risk factors and related pathology 4. Identify and describe the investigation and treatment options for prostate cance r(biopsy, bone scan, MRI) and be able to explain why prostate cancer tends to spread to bones 5.

1
Q

State some examples of common symptoms of prostate cancer in men?

A
  • Urinary complaints or retention
  • Back pain
  • Haematuria
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2
Q

Describe the position of the prostate?

A
  • Gland lying beneath bladder

- encircles urethra.

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3
Q

Examples of symptoms found in patients with advanced disease?

loads

A
  • Cancer cachexia
  • Bony tenderness
  • Lower-extremity lymphedema
  • Deep venous thrombosis
  • Adenopathy
  • Overdistended bladder due to outlet obstruction
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4
Q

Cancer cachexia

A

Wasting syndrome characterised by :

  • weight loss.
  • anorexia
  • asthenia
  • anaemia
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5
Q

Asthenia

A

Abnormal physical weakness or lack of energy

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6
Q

Adenopathy

A
  • Disease of lymph nodes
  • abnormal in size or consistency.
  • Inflammatory type.
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7
Q

Lymphedema

A
  • Swelling occuring in arms or legs.

- Commonly caused by removal of or damage to lymph nodes as part of a cancer treatment.

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8
Q

State diagnosis methods for prostate cancer

A
  1. Elevated prostate-specific antigen PSA level
  2. Abnormal digital rectal examination findings DRE
  3. Biopsy
  4. Screening
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9
Q

What is prostate-specific antigen?

A
  • Protein produced by normal prostate epithelial cells.
  • Enzyme, results in liquefaction of ejaculate to increase sperm motility.
  • Rising levels of PSA associated with prostate cancer.
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10
Q

Describe the structure and attributes of PSA?

A

33-kd protein consisting of a single chain glycoprotein of 237 AA residues.

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11
Q

How may a digital rectal examination DRE diagnose prostate cancer?

A

Most patients diagnosed with prostate cancer may have normal DRE results but abnormal PSA readings.

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12
Q

What are 3 well established risks of prostate cancer?

A
  1. Increasing age
    - median age at diagnosis is 68
  2. Ethnicity
    - afro-caribbean
  3. Heredity
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13
Q

Describe the staging of tumour node metastasis?

A 
T1c - not palpable on DRE 
T2 - Palpable on DRE 
T3 - outside the prostate 
T4 - Invades surrounding structures 
N - Lymph nodes 
M - Metastases
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14
Q

What is the Gleason’s pattern?

A

Standard approach for grading prostate cancer.

Based on pathologic evaluation of a prostatectomy specimen.

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15
Q

Describe the Gleason’s score?

A
  1. Small uniform glands
  2. More stroma between glands
  3. Distinctly infiltrative margins
  4. Irregular masses of neoplastic glands
  5. Only occasional gland formation.
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16
Q

Adenocarcinoma

A

A malignant tumour formed from glandular structures in epithelial tissue.

17
Q

What is atypical small acinar proliferation?

aka ASAP

A
  • Unusual cells present in prostate

- however not clear if they are cancerous or what are they.

18
Q

How may a clinical interpret a gleason score?

A

Area of cancer is given a grade from 1 -5.
2 most predominant areas are totalled to give a score from 2 -10.
GS 2,3,4 don’t exist anymore
Low risk GS 5 & 6
Intermediate risk GS 7
High risk GS 8 - 10

19
Q

What does the prostate gland consist of?

A

Glandular epithelium surrounded by prostatic stromal cells.

- these stromal cells provide growth factors.

20
Q

Describe normal prostate glandular differentiation?

what is required?

A

Requires testosterone metabolite - DHT (5a-dihydrotestosterone)

DHT binds to the androgen receptor —> prostate stromal cells —> produce essential growth factors required for glandular cell differentiation.

which is needed for cell differentiation and function (secretion of PSA)

21
Q

Although elevated PSA might be a marker of prostate cancer, describe what may be other conditions that show an elevated PSA level?

A
  • Prostatitis
  • DRE
  • UTI
  • Catheter
  • Urinary retention
22
Q

What may bone metastasis cause?

A

Bones to release their calcium into the bloodstream, resulting in high levels of calcium building up in blood.

Condition known as hypercalcemia.

23
Q

Compare the spread of transitional zone tumours and peripheral zone tumours?

A
  1. Transitional zone tumours - spread to bladder neck

2. Peripheral zone tumours - extend into the ejaculatory ducts and seminal vesicles

24
Q

Describe hormone therapy as a treatment for metastatic prostate cancer?

A

Mainstay is hormone manipulation. Androgen deprivation therapy, ADT.
- prostate cancer is androgen dependent
Androgen deprivation leads to tumour regression.

25
Q

Describe the physiology for androgen deprivation therapy?

A

ADT reduce ability of androgen to activate androgen receptors in prostate.

26
Q

What are the various sites that ADT will target on the androgen axis?

A
  • Anti-androgens block cystolic androgen receptors
  • LHRH analogues hyperstimulate the pituitary, after initial surge will suppress LH
  • LHRH antagonists directly suppress LHRH production.
27
Q

A patient with suspected prostate cancer may present with…

A

Mostly asymptomatic but can present with bone pain or spinal cord compression.

28
Q

Local treatment of prostate cancer?

A

Active surveillance
Radical prostatectomy
Radiotherapy

29
Q

What is surgical castration?

A

Orchiectomy

  • hormone therapy
  • removal of testicles
30
Q

Give examples of anti-androgens?

A

Drugs that stop androgens from working thus they cant cause tumor growth.

  • flutamide
  • bicalulatmide
  • nilutamide

Urogenital Y2 (16 decks)

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