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Year 4 CCC > Prostate cancer > Flashcards

Prostate cancer Flashcards

1
Q

Prostate cancer has now overtaken which other cancer as the commonest male cancer in the UK?

A

Lung cancer

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2
Q

How many cases are there of prostate cancer per year in the UK?

A

> 30,000

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3
Q

What is the lifetime risk of prostate cancer for a man?

A

1 in 14

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4
Q

Prostate cancer is rare in men below what age?

A

<50

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5
Q

85% of men diagnosed with prostate cancer are what age and above?

A

65 years or older

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6
Q

What % of men over the age of 80 have histological evidence of cancer in the prostate?

A

70%

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7
Q

Despite the rise in incidence of prostate cancer, the number of deaths per year due to it are relatively low, why is this?

A

Often prostate cancer ‘outlives’ the patient, in other words, they die of other causes

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8
Q

What is the most important risk factor for developing prostate cancer?

A

Increasing age

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9
Q

New evidence suggests there is a hereditary prostate cancer locus on which chromosome?

A

1q 24-25

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10
Q

In which ethnicity is prostate cancer most common?

A

African-Americans

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11
Q

Prostate cancer is predominately what type of carcinoma?

A

Adenocarcinoma

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12
Q

70% of prostate cancer arises in which part of the gland?

A

Peripheral zone of the gland

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13
Q

Which system is used to grade prostate cancers?

A

Gleason score

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14
Q

What is measured help aid diagnosis of prostate cancer?

A

PSA - prostate specific antigen

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15
Q

Why is the measurement of PSA a screening test with limitations?

A

Because PSA naturally increases with age and may be elevated in someone with benign prostatic hyperplasia and prostatitis

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16
Q

What % of men found to have a PSA greater than 4 ug/l will be found to have cancer on biopsy of the prostate?

A

25%

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17
Q

There are cut-offs used to aid PSA levels and indication for prostate biopsy, what are they? (4)

A
  1. > 70 years = 6.5ug/l
  2. 60-70 years = 4.5ug/l
  3. 50-60 years = 3.5ug/l
  4. 40-50 years = 2.5ug/l
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18
Q

In addition to only 25% of people with a raised PSA actually having cancer, what is the other problem with PSA testing?

A

Only 1/3 of prostate cancers will cause a raised PSA (above 4ug/l) therefore many men may have prostate cancer without a raised PSA

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19
Q

What other screening test/examination is important with regards to prostate cancer and diagnosis?

A

Digital rectal examinations - 40% of men with palpable abnormalities will have a tumour

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20
Q

If the PSA level is very high e.g. 20ug/l, what is this suggestive of?

A

Highly suggestive of cancer

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21
Q

What can be the presenting signs/symptoms of prostate cancer? (urinary and locally advanced)

A
  1. Urinary symptoms - frequency, nocturia, poor stream, retention, haematuria (these are usually due to coincident benign prostatic hyperplasia)
  2. Locally advanced disease - rectal symptoms e.g. tenesmus, bleeding, haemospermia, impotence, ureteric obstruction and renal failure
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22
Q

What is the first line treatment for prostate cancer with metastatic spread?

A

Surgical castration with appropriate hormone therapy.

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23
Q

Why can prostate cancer be controlled relatively well with hormone therapy?

A

Because the tumour growth is androgen dependent

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24
Q

Some patients do not want a surgical castration to treat prostate cancer, and may opt for a medical castration. What is the name of the hormone agonist used as a medical castration?

A

Luteinizing hormone-releasing hormone (LHRH) agonist

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25
Q

Name some LHRH agonists? (3)

A
  1. Goserelin (AKA zoladex)
  2. Buserelin
  3. Leuprorelin
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26
Q

What palliative treatment is often used for people with metastatic prostate cancer?

A

Radiotherapy is often used to alleviate symptoms

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27
Q

People diagnosed with early-stage prostate cancer have several treatment options and the most appropriate is dependent on what factors?

A
  1. Life expectancy of the patient, taking into account age and co-morbidities
  2. Predicted natural history of the prostate cancer, determined by stage, PSA and Gleason score
  3. The patients preferences
28
Q

In terms of staging, PSA level and Gleason score, what is a low risk prostate cancer?

A

Staging: T1-2a
PSA: <10ug/l
Gleason: 6

29
Q

In terms of staging, PSA and Gleason score, what is intermediate risk prostate cancer?

A

Staging: T2b-c
PSA: 10-20ug/l
Gleason: 7

30
Q

In terms of staging, PSA and Gleason score, what is high risk prostate cancer?

A

Staging: T3-4
PSA: >20ug/l
Gleason: 8-10

31
Q

What is the first-line treatment for patients <70 years old without significant co-morbidities and a low or intermediate risk cancer?

A

Radical surgery (prostatectomy), as it gives excellent disease-free survival rates

32
Q

For patients being treated for prostate cancer with radiotherapy, either curative or as an adjuvant, what are the side effects? (3)

A
  1. Acute radiation cystitis/urethritis with urinary frequency and poor stream
  2. Tenesmus, pain and passage of mucus and blood
  3. Late effects include impotence in approx. 50%
33
Q

What is brachytherapy?

A

Permanent implantation of radioactive iodine seeds (125l) under transrectal ultrasound control which can deliver a dose of 140Gy to the prostate

34
Q

Why is brachytherapy sometimes preferred to radiotherapy?

A

It avoids the inconvenience of 7-8 weeks of radiotherapy

35
Q

When is brachytherapy contraindicated?

A
  1. Patient already has marked urinary outflow symptoms
  2. Very small or large prostate volumes
  3. Previous TURP (transurethral resection of the prostate)
36
Q

What is the prognosis for early prostate cancer detection and treatment?

A

Excellent - medial survival is >10 years for patients treated by either radical prostatectomy or radiotherapy

37
Q

For metastatic prostate cancer, what is the prognosis?

A

Median duration of response to hormone therapy is 18-24 months, and after the development of hormone-refractory disease, the median survival is 12-18 months …so 2-4 years?

38
Q

Which is the most common cancer in men aged between 20-40 years?

A

Testicular cancer

39
Q

Why is metastatic testicular cancer in the past 30 years become a medical oncology success?

A

Because it is one of the few solid tumours for which the majority of patients with metastatic disease can expect to be cured

40
Q

How many cases of testicular cancer are there each year in the UK?

A

2000

41
Q

What % of testicular cancers are of germ cell origin?

A

95%

42
Q

Testicular cancer is categorised as seminoma or non-seminoma, which one is more common?

A

Seminoma is the most frequent pathology - 55% and 45% non-seminoma

43
Q

When are men at an increased risk of developed testicular cancer? - what may they have a history of… (6)

A
  1. Undescended testis
  2. Previous testicular cancer
  3. Testicular carcinoma in-situ
  4. Family history of testicular cancer
  5. Klinefelter’s syndrome
  6. Atrophic testis and infertility
44
Q

In terms of tumour markers, what do non-seminomatous germ cell tumours (NSGCTs) AKA teratoma produce in 75% of cases?

A

Humain chorionic gonadotrophin (HCG) and/or alpha fetoprotein (AFP)

45
Q

How does prostate cancer tend to present?

A

Most commonly presents with a hard testicular lump, which may be painless, or mistaken for epididymo-ochitis

46
Q

Men with tumours producing high levels of HCG may develop what as a result?

A

Gynaecomastia

47
Q

How many metastatic testicular cancer present? (4)

A
  1. Lumbar back pain associated with bulky para-aortic lymphadenopathy
  2. Cough and dyspnoea with multiple lung metastases
  3. SVC obstruction with mediastinal lymphadenopathy
  4. CNS symptoms/signs with brain metastases
48
Q

How are testicular germ cell tumours investigated? (3)

A
  1. Ultrasound scan of both testes
  2. CXR
  3. Tumour markers (AFP, HCG, LDH)
49
Q

What is important to consider in a man with testicular cancer facing treatment?

A

Sperm storage - should be considered at an early stage where patients are likely to require further therapy. It is important to remember that up to 50% of patients with a germ cell tumour may be sub-fertile at presentation

50
Q

What is the staging for testicular cancers?

A

RMH staging

51
Q

If a male has testicular carcinoma in situ, how is this normally treated?

A

Low dose radiotherapy (20Gy in 10 fractions)

52
Q

Why is this treatment for testicular CIS first-line?

A

Because in the majority of cases it will avoid orchidectomy and not affect Leydig cell function, and long-term hormone therapy should not be necessary

53
Q

Which treatment is the key to the improvement in prognosis of metastatic testicular cancer?

A

Chemotherapy - BEP regimen = bleomycin, etoposide, cisplatin

54
Q

What are the signs/symptoms of metastatic prostate cancer? (5)

A
  1. Anaemia
  2. Bone pain
  3. Weight loss
  4. Malaise
  5. Spinal cord compression
55
Q

What investigations are carried out for a patient with suspected prostate cancer?

A

Multi-parametric MRI and biopsy

56
Q

Why is it important to perform the MRI before biopsy?

A

As the biopsy may not be needed, and biopsy carries risk of infection/life threatening sepsis

57
Q

What is the lowest Gleason score possible for a cancer found on biopsy?

A

6 (3+3)

58
Q

How are Gleason scores calculated?

A

Based upon adding together the numbers of differentiated tumour scored either 3, 4 or 5. These two numbers are added together for example if it is low risk 3+3, if it is the worst, it’ll be 5+5. If it is 4+3, this is worse than 3+4.

59
Q

What is active surveillance or monitoring?

A

Men who have low-risk cancer who could be treated, but will suffer the ill effects/toxicity of that treatment, and delay treating until it comes to a point where treatment benefits outweigh the side effects. - MRIs and biopsies

60
Q

Watchful waiting is what?

A

Older men in which the prostate cancer will outlive them, and their PSA may be monitored and symptoms

61
Q

Which Gleason score would indicate a bone scan?

A

7

62
Q

For radiotherapy of the prostate, why does the rectum need to be empty and bladder full?

A

If there are bowel contents in the rectum, it will move the prostate and depend upon how much there is, if it is empty, it will be in the same place. Also the bladder needs to be full to push the small intestines up - keep them away

63
Q

What are the main therapies for advanced prostate cancer?

A

Androgen deprivation therapy

Radiotherapy for bony pain

64
Q

What are the adverse effects of androgen deprivation therapy?

A
  1. Hot flushes
  2. Sexual dysfunction/shrinkage penis and testes
  3. Loss muscle bulk and strength
  4. Memory effects and mood disturbance
  5. 10% weight gain and higher risk DM
65
Q

How do bone mets appear on scans?

A

Sclerotic

Lytic

66
Q

Prostate tends to give what kind of bone mets?

A

Sclerotic

67
Q

What is the best investigation for staging prostate cancer and why?

A

MRI - because CT scan is not useful due to the pelvis causing lots of bony artefacts - not providing enough clarity

Year 4 CCC (17 decks)

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