What are the three modes of metastatic spread of prostate cancer?
lymphatic
haematogenous
transcoelomic
What is transcelomic spread?
a route of tumour metastasis across a body cavity, such as the pleural, pericardial, or peritoneal cavity.
What are the categories of symptoms that you can get with prostate cancer?
Systemic:
- non-specific
- specific
- paraneoplastic symptoms
Local symptoms
Give examples of non-specific constitutional symptoms in prostate cancer
weight loss
anorexia
fever
anaemia - normocytic
Give examples of specific constitutional symptoms in prostate cancer
hypercalcaemia causing:
- anorexia
- thirst
- confusion
- collapse
marrow replacement causing:
- purpura
- anaemia
- immune suppression
Give examples of paraneoplastic symptoms that can be seen in prostate cancer
Endocrine:
- Cushing’s disease
neurological:
- dementia
- cerebellar degeneration
- peripheral neuropathy
dermatological:
acanthosis nigricans
haematological:
erythrocytosis
What is the most common cancer in men?
prostate!
What are the three most common cancers in men?
lung
bowel
prostate
Which cancer causes the greatest number of deaths in men?
lung
Which 3 cancers cause the greatest number of deaths in men?
lung
prostate
bowel
What has the trend been for prostate cancer incidence?
it is on the rise
What is the percentage of people who have a family history of prostate cancer who then go on to develop prostate cancer later in life?
10-15%
What is the lifetime risk of diagnosis of prostate cancer?
12-16%
advanced prostate cancer is life threatening T or F?
true
localised prostate cancer is life threatening T or F?
false
in which part of the prostate gland does prostate cancer develop?
peripheral zone
in which part of the prostate gland does BPH develop?
transitional zone
what proportion of people diagnosed with prostate cancer will die of prostate cancer?
1 IN 4 (may be 1 in 3)
localised prostate cancer presents with symptoms T or F?
FALSE - localised prostate cancer doesn’t present with any symptoms
what is the biological reason for increase of incidence in prostate cancer?
ageing popln
does FHx affect prostate cancer?
yes at greater risk of developing prostate caner if you have a first degree relative who had prostate cancer
what type of cancer is prostate cancer?
adenocarcinoma - as the prostate is a gland
is prostate cancer a single mass?
no - it is multifocal
where does prostate cancer metastasise to?
lymph nodes bone lung liver brain
which cancer classically mets to bone?
prostate thyroid breast kidney lung
what is the pathogenesis of prostate cancer?
TMPRSS2-ERG gene fusion
prostate cancer is sensitive to androgens
when these genes fuse, ERG is upregulated and ERG is an oncogene - results in loss of tumour suppressor genes and upregulation of oncogenes
TMPRSS2 is also upregulated and when androgens bing to the androgen receptor on TMPRSS2 more serine protease is formed as TMPRSS2 normally produces a serine protease
what is PSA?
a serine protease responsible for liquefaction of semen
what is the most common reason for PSA increase?
BPE
how is prostate cancer diagnosed?
LUTS history PSA Transrectal ultrasound scan TRUSS prostate biopsy grading and staging of cancer after biopsy
what is the common grading system used for prostate cancer?
Gleason grading system
What is the difference between grade and stage of tumours?
grade = how aggressive the tumour is
stage is how far the tumour has spread in the body
can be correlated as a more biologically aggresssive disease will tend to spread quicker
what system is used to stage prostate cancer?
TNM as usual
what factors can predict mets in prostate cancer?
high grade
high PSA
what the prostate feels like
What are T1, T2 and T3 in prostate cancer?
T1 - no palpable tumour on DRE
T2 - palpable tumour confined to prostate
T3 - palpable tumour extending beyond prostate
How can we detect whether the prostate cancer has spread to lymph nodes
MRI scan
CT scan
how can we detect whether prostate cancer has spread to bone?
Technetium bone scan
what imaging can be offered before biopsy to increase the accuracy of the biopsy?
multi-parametric MRI scan
what are the treatment options for localised prostate cancer?
curative strategy ie:
surgery - radical prostatectomy
radiotherapy - external beam, brachytherapy
adjuvant hormones
focal therapy - high intensity ultrasound
or active observation/watchful waiting
how is metastatic prostate cancer treated?
palliative with hormones
what are the arguments for radical treatment of localised prostate cancer?
curative treatment
high mortality in prostate cancer
reduced pt anxiety
studies show benefit of surgery
what are the arguments against radical treatment of localised prostate cancer
disease of the elderly
competing causes of death
30% of men with prostate cancer die of it but 70% don’t
adverse effects of treatment
How is locally advanced prostate cancer treated?
radiotherapy
radical prostatectomy
what is the first line treatment for metastatic disease?
medical castration ie orchiectomy
with docetaxel chemo
what other treatments are available for advanced prostate cancer apart from castration and chemo?
medical - GnRH analogues and LH antagonists
peripheral androgen receptor antagonists