What is are the principles of luteinizing hormone releasing hormone (LHRH) agonist therapy?
GnRH stimulation of LH hormone release is usually pulsatile so constant stimulation reduces LH hormone release therefore testosterone.
The initial dosing must be accompanied with an anti-adrogenic agent (bicalutamide) to counteract the initial burst in testosterone
What is the treatment of choice for metastatic prostate cancer?
Docetaxel (anti-mitotic chemotherapy)
What is active surveillance? When is it used?
6monthly PSA and DRE
For a GLEASON 6 prostate cancer in a patient who is able to tolerate the treatment if required
What is the difference between active surveillance and watch full waiting?
In active surveillance the intent is for cure and the screening is more rigorous as the patient is more likely to be able to tolerate the required therapy
In watchful waiting the intention is to paliate therefore the screening is less rigorous. The patient is unlikely to tolerate the required therapy
What are the differentials for an elevated PSA?
What are the options of androgen depreviation therapy?
Luteinizing hormone releasing hormone agonists (goserelin)
Outline the Gleason scoring system and the implications of scores?
6 is low risk
7 is medium risk
8-10 is high risk
What are the pro's and con's of PSA screening?
- It's a safe, reliable test
- Early treatment is effective at lowering mortality and has low side effects
- Overtreatment and over diagnosis
- 2/3 positive tests won't be prostate cancer
What does BPH stand for?
Benign prostatic hyperplasia
How many men are diagnosed and die of prostate cancer every year in Australia?
What are investigations available to stage prostate cancers?
How is the diagnosis of prostate cancer confirmed?
Transurethral/transperineal US guided biopsy with 12-20 cores taken and sent for Gleason score
What is normal for PSA?
What are some side effects of adrogenic depreviation therapy?
CNS - Low mood, cognitive change
CVS - Hypercholesteraemia, IHD risk
Bone - Osteoporesis
General - Low lidido, lethargy
Outline how the Gleason score works
12-20 biopsies are taken and scored with a grade of 1-5 depending on the glandular pattern of differentiation. The two highest scores are added to get a score out of 10
2-4 = Well differentiated cancer
5,6 = Intermediate grade tumour
7 = Moderate to poorly differentiated cancer
8-10 = High-grade tumour
What are some risk factors for prostate cancer?