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PA40157 Cancer > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

(49 cards)

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1
Q

What is the most common cancer in men??

A

Prostate

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2
Q

Does the incidence of prostate cancer increase or decrease with age? and when does it peak?

A

Increase

80 years

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3
Q

What are the risk factors for developing prostate cancer?

A 
Age
Race
Genetic
Androgens
Diet high in fat and red meat
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4
Q

What are the protective factors against prostate cancer?

A

Frequent ejaculation

Diet high in lycopenes (tomatoes)

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5
Q

Why can surgery for prostate cancer be difficult?

A

the prostate is surrounded by lots of other organs

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6
Q

what is the clinical presentation of prostate cancer?

A 
Lower urinary tract symptoms:
hesitancy
Decreased void pressure
Frequency
Urgency
Nocturia
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7
Q

What are the locally invasive symptoms of prostate cancer?

A

Perineal pain
Impotence
Incontinence
Haematospermia

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8
Q

What are the metastatic symptoms of prostate cancer?

A 
Bone pain
Hypercalcaemia
Spinal cord compression
Sciatica/paraplegia
Fracture
Lymphoedema
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9
Q

What is used to diagnose prostate cancer?

A 
Digital rectal examination
PSA (prostate specific antigen)
Transrectal ultrasound
CT/MRI
Radiolabelled bone scanning
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10
Q

What is the normal PSA level?

A

0-4ng/ml

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11
Q

What are the treatment options for prostate cancer?

A 
Watchful waiting
Surgery-radical prostatectomy
Radiotherapy
Brachytherapy
Hormonal therapy
Chemotherapy
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12
Q

Who is considered for surgery for prostate cancer?

A

Patients with T1 or T2 disease who have at least 10 year life expectancy

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13
Q

Who is considered for radiotherapy for prostate cancer?

A

Patients who are not suitable for surgery but have good life expectancy and localised disease

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14
Q

What are the side effects of radical prostectomy?

A

Impotence

Incontinence

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15
Q

What is brachytherapy?

A

Delivers radiation through implantation of needles containing radioactive pellets into the prostate gland. Pellets usually left in permanently and emit low dose of radiation over several weeks or months

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16
Q

What is brachytherapy used in combination with as primary therapy for prostate cancer?

A

Radiotherapy in intermediate/high risk prostate cancer

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17
Q

What is hormonal therapy used for in prostate cancer?

A

Locally advanced and metastatic cancer

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18
Q

What can hormonal therapy be combined with in intermediate/high risk disease?

A

Radiotherapy or radical prostectomy

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19
Q

Most patients die within how many years of developing hormone refractory prostate cancer?

A

2 years

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20
Q

What is the theory for using hormonal therapies?

Study These Flashcards
A

They block androgen drive that sustains most prostate cancers

21
Q

Testosterone from the testes is under the control of what?

Study These Flashcards
A

Luteinizing hormone

22
Q

Where is LH released from?

Study These Flashcards
A

pituitary gland

23
Q

What stimulates the pituitary gland?

Study These Flashcards
A

LHRH from the hypothelamus

24
Q

Why is pulsatile release of LHRH important?

Study These Flashcards
A

As receptors for LHRH will become desensitised if they are permanently occupied

25
What are the five ways of achieving androgen blockade?
``` Bilateral orchidectomy LHRH analogues Androgen blockers Maximal androgen blockade Intermittent hormone therapy ```
26
How does bilateral orchidectomy work?
Stops testicular secretion of testosteron
27
How do LHRH analogues work?
Disrupt the normal pulsatile release of LHRH. Initially increased LH release followed by decreased LH and testosterone
28
Why is an androgen blocking drug given in the first few weeks of treatment with LHRH analogues?
Initial increase in LH can cause transient increase in tumour volume
29
What are two examples of LHRH analogues?
Goserelin and triptorelin
30
How do androgen blockers work?
Compete with DHT at receptor level within prostate cancer
31
Name one androgen blocker
Bicalutamide
32
How does maximal androgen blockade treatment work?
Combination of LHRH analogue and anti-androgen drug
33
How does intermittent hormone therapy work?
Withdrawal of LHRH analogue may allow growth of hormone-sensitive cells within tumour which can be treated again as PSA or symptoms dictate
34
What are the side effects of hormonal therapies?
``` Impotence Loss of libido Gynaecomastia Breast tenderness Hot flushes Depression and mood changes Fatigue ```
35
How does abiraterone work?
Oral androgen inhibitor for metastatic prostate cancer. inhibits androgen production from testes, adrenal gland and prostate tumour cells
36
When is abiraterone licensed?
1st line where chemotherapy is not yet clinically indicated i,e, patient is asymptomatic/mildly symptomatic. Also licensed after failure of hormone therapy or chemotherapy
37
What must abireterone be given with?
Prednisolone 5mg PO bd
38
What can abiraterone cause?
Cortisol deficiency
39
How is Abiraterone dosed?
1g OD without food
40
What are the side effects of abiraterone?
``` Peripheral oedema Hypokalaemia Hypertension UTI Elevated LFTs- monitor every 2 weeks for 1st 3 months ```
41
How does enzalutamide work?
Potent androgen receptor signalling inhibitor that blocks several steps in the androgen receptor signalling pathway. Inhibits binding of androgens to androgen receptors, inhibits nuclear translocation of activated receptors and inhibits the association of the activated androgen receptor with DNA
42
What is enzalutamide licensed for?
metastatic prostate cancer where chemo is not yet clincially indicated. Also for treatment of metastatic prostate cancer where disease has progressed on or after docetaxel therapy
43
What are the side effects of enzalutamide?
``` Headache Hot flushes Memory problems Visual hallucinations Risk of seizures ```
44
When is chemo used for prostate cancer?
Metastatic disease which is refractory to hormone therapy/abiraterone/anzalutamide
45
What is the commonly used chemo for prostate cancer?
Docetaxel + prednisolone
46
What is the chemo regimen for prostate cancer?
Docetaxel 75mg/m2 IV infusion day 1 Pred 5mg PO bd continuously Given every 21 days for up to 10 cycles
47
How does docetaxel work?
Disrupts microtubular network of cells during cell division, so mitosis cannot occur-->cell death
48
What are the side effects of docetaxel and prednisolone?
``` Bone marrow suppression Severe alopecia Nausea and vomiting Myalgia/arthralgia Fluid retention Hypersensitivity ```
49
What needs to be prescribed for 3 days starting on the day before chemo?
Dexamethasone 8mg bd

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