Prostate Cancer Flashcards
(19 cards)
What is the most common malignancy affecting males?
Prostate cancer
Which zone of the prostate do 80% of cancers arise from?
Peripheral zone - this is a palpable zone which is why it’s so important to do a DRE on all patients with LUTS
How is prostate cancer commonly picked up?
Raised PSA on routine testing
True / False: There is a screening programme for prostate cancer
False
What is the pathology of the vast majority of prostate cancers?
Adenocarcinoma
What investigations are done in prostate cancer?
PSA DRE Transrectal ultrasound scan and biopsy MRI scan for staging May also have bone scan
What is PSA?
A physiological serine protease produced by the prostate gland to reduce the viscosity of semen, allowing sperm to travel
What are the benefits and limitations of PSA testing?
Benefits:
- Earlier detection of prostate cancer i.e. before symptoms arise / before spread
- Aids a diagnosis of suspected prostate ca.
Limitations:
- Not diagnostic
- Organ specific but not tumour specific…it can be raised for other reasons (prostatitis, UTI, BPH)
- Some of the most aggressive cancers don’t produce PSA
- Over-identification of cancers which wouldn’t ever cause problems to the patient
- No differentiation of a slow growing tumour from an aggressive one
List some causes of a raised PSA
Prostate cancer BPH Prostatitis UTI Trauma e.g. in sigmoidoscopy
What is the Gleason score?
A score derived from the histology of a prostate cancer which helps to guide treatment and predict prognosis
How is the Gleason score calculated?
Most common grade of tumour in the sample + the highest grade in the sample = Gleason score
Each component scored out of 5, so the worst score is 10
What are the treatment options for localised prostate cancer?
Active surveillance
Radical prostatectomy
External beam radiotherapy
Brachytherapy
How is T1 and T2 prostate cancer defined?
Localised prostate cancer
How is T3 and T4 prostate cancer defined?
Locally advanced prostate cancer
Where are the treatment options for locally advanced prostate cancer?
Radical prostatectomy
Hormone therapy
External beam radiotherapy
Brachytherapy
What is the treatment for metastatic prostate cancer?
Hormone treatment
What is Goserelin and how does it work?
A GnRH analogue (also know as LHRH analogue) inhibit gonadotrophin release from the pituitary. Their initial action is to increase it’s production so an anti-androgen should be prescribed alongside to reduce the risk of tumour ‘flare’.
Give the name of an anti-androgen used alongside Zoladex in prostate cancer
Cyproterone acetate
Why is an anti-androgen used alongside Zoladex in prostate cancer?
Zoladex (goserelin) is a GnRH analogue which inhibits gonadotrophin release from the pituitary. However, their initial action is to increase it’s production so an anti-androgen should be prescribed alongside to reduce the risk of tumour ‘flare’.
