FN: Prostate Cancer Flashcards Preview

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Flashcards in FN: Prostate Cancer Deck (16):
1

Epi

Commonest male Ca
3rd commonest cause of male Ca death
PrevalenceL 80% of men >80 yrs
Race: increased in blacks

2

Pathology

Adenocarcinoma
Peripheral zone of prostate

3

Presentation

Usually asymptomatic
Urinary: nocturia, freqeuncy, hesitancy, poor stream, terminal dribbling, obstruction
systemic: wt. loss, fatigue
Mets: bon epain

4

Examination

Hard irregular prostate on PR
Loss of midline sulcus

5

Spread

Local: seminal vesicles, bladder, rectum
Lymph: para-aortic nodes
Haem: slcerotic bony lesions

6

Imaging

Bloods: PSA, U+E, acid and alk phos, Ca
Imaging:
-XR chest and psine
- TRansrectal US + biopsy
- Bone scan
- Staging MRI - contrast enhacing magnetic nanoparticles increased detection of affect nodes

7

PSA

- Proteolytic enzyme used in liquefaction of ejaculation
- Not specific for prostate CA - raised with age, PR, TURP and prostatitis
- >4ng/ml: 40-90% sensitivity, 60-90% specificty: only 1-in-3 will have Ca
- Normal in 30% of small cancers

8

Prostate cancer grading

Gleason grade

9

Staging

TNM see notes

10

Prognostic factors

Help determine whether to pursue radical Rx
Age
Pre-Rx PSA
Tumour stage
Tumour grade

11

Mx

- Difficult to know which tumours are indolent and will not - mortality before something else
- Radical therapy association with significant morbidity

12

conservative Mx

Active monitoring close monitoring with DRE and PSA

13

Radical therapy

1. Radical prostatectomy (+ goserelin if node +ve)
- perfomred laparoscopically with robot
- Only mproves survival vs. active monitoring if

14

Medical management

- Used for metastatic or node + ve disease
- LHRH analogues e.g. goserelin, inhibit pituitary gonadotrophins - reduced testosterone
- Antiandrogens e..g cyproterone acetate, flutamide

15

Symptomatic

TURP for obstruction
Analgesia
Radiotherapy for bone mets/cord compression

16

Screening with PSA

- populatino based screening not recommened in the UK
- PSA not an accurate tumour marker
- ERSPC trial showed small mortaility benefit, PLCO trial showe dno benefit
- Must balance mortality benefit with harm caused by over diagnosis and over treatment of indolent cancers

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