Prostate cancer Flashcards
Most common cancer in men
Prostate
Type of cancer
Majority are adenomcarcinomas in the peripheral zone of the prostate
Risk factors
Increasing age
Family history
Black African or Caribbean origin
Tall stature
Anabolic steroids
Presentation
Asymptomatic
Lower urinary tract symptoms
Haematuria
Erectile dysfunction
Symptoms of advanced disease/ metastasis
PSA
Produced by epithelial cells of prostate
Causes of raised PSA
Prostate cancer
BPH
Prostatitis
UTI
Vigorous exercise
Recent ejaculation or prostate stimulation
Prostate examination
Benign: smooth, symmetrical, slightly soft, central sulcus
Infection: enlarged, tender, warm
Cancerous: firm, hard, asymmetrical, craggy, loss of central sulcus (require 2 week wait)
Prostate biopsy
Depends on MRI findings
Multiple needs to take samples from different areas
Either transrectal US guided biopsy or transperineal biopsy
Risks of prostate biopsy
Pain
Bleeding
Infection
Urinary retention
Erectile dysfunction (rare)
Isotope bone scan
Used to look fro bony metastasis
Gleason grading system
Based on histology of the biopsy
The more poorly differentiated the tumour, the worse the prognosis
Add most prevalent number to the second most prevalent number
Gleason score
6 is low risk
7 is intermediate risk
8 or above is high risk
Management
Watch and wait (older, multiple co-morbidities, low Gleason score)
Radiotherapy (potentially curative and palliative)
Surgery
Hormone therapy
External beam radiotherapy comlications
Proctitis (causes pain, altered bowel habits, rectal bleeding and discharge)
Prednisolone suppositories can help reduce inflammation
Brachytherapy
Implant radioactive seeds into prostate
Can cause inflammation in other nearby organs (cystitis and proctitis)
Can also cause erectile dysfunction, incontinence and increased risk of bladder or rectal cancer
