prostate cancer Flashcards
(40 cards)
what is the most common malignancy in men?
prostate cancer
what are the 4 zones of the prostate?
- 4 main zones: peripheral (posterior), fibromuscular (anterior), central (central) and transitional zone (surrounding urethra)
what are the RF for prostate cancer?
- Age >50
- Black
- Family history of prostate cancer
- Family history of heritable cancers eg breast or colorectal
- High levels of dietary fat
what symptoms can be seen with prostate cancer?
asymptomatic - incidentally picked up
lower urinary tract symptoms
: haematuria, haematospermia, weight loss, weakness, fatigue, bone pain
why might bone pain occur with prostate cancer?
likely to met in bones especially hip/ pelvis
what are lower urinary tract symptoms?
frequency, uregency, nocturia and hesitancy, dysuria and post void dribbling are most common
what are important aspects of history to ask about?
- Past medical history including hospitalisation, surgical procedures and history of pelvic radiation
- Medications
- Family history: prostate cancer in a first degree relative under 65 and breast cancer BRCA2 gene
- Social: alcohol intake, smoking (affects prognosis) and recreational drug use
what would a DRE examination reveal to indicate PC?
asymmetrical prostate, nodular and indurated
what regions of the prostate can a DRE palpate?
may only detect in posterior and lateral aspects due to be only palpable regions.
what are differentials of PC?
BPH
chronic prostatitis
urethral instrumentation
UTI
how would you differentiate between BPH and PC?
Benign prostatic hyperplasia: DRE enlarged but symmetrical
- Biopsy would differentiate between
how would you differentiate chronic prostatitis and PC?
Chronic prostatitis: symptoms develop over 3mths to a 1yr
- Microscopy of prostate secretions reveal leukocytes and inflammation
- PSA mildly elevated
- Will resolve with antibiotics
what would point more towards urethral instrumentation?
history of recent intervention will temporary elevate PSA
what can elevate PSA?
cancer, BPH, prostatitis, UTI (avoid testing for 6weeks after0, VIGROUS EXERCISE, sexual activity (avoid ejaculation for 48hrs before test), DRE- avoid for 7days prior to test, catheter – avoid 6weeks before test, biopsy – avoid for 6weeks prior to test
what can U&Es show while investigating PC?
cancer may obstruct ureters leading to hydronephrosis and kidney dysfunction
what scale is used for a multiparametric MRI?
- Multiparametric MRI: if PSA indicates, gives a 5point likert scale biopsy required in those with 3+
why would you do a DEZA scan?
boney mets
why would you do a CT abdo, pelvis?
for mets
what is a PSMA PET used for?
- PSMA PET for detecting mets in those with low PSA
what methods can be used for a prostate biopsy?
- Template transperineally biopsy under GA
- Transperineal biopsy under LA
- Transrectal ultrasound (TRUS) guided needle biopsy
- MRI- TRUS fusion guided needle biopsy
- PSA -membrane PET scan is most sensitive for detecting recurrent disease
how is PC graded?
gleason grading
can biopsy miss diagnosis of PC?
up to 20%
what are the advantages of PSA screening?
- Improved prognosis by early detection
- Less radical treatment due to early curing
- Reassurance to those with negative results
what are the disadvantages of screening?
- Anxiety and morbidity with false positives
- Unnecessary intervention with false positives
- ## Hazards of screening eg radiation
