prostate cancer Flashcards
what are the risk factors of prostate cancer?
- age (peak in 70s)
- family history
- genetics (BRCA, HPC1)
- ethnic origin (afro- Caribbean, African American)
how does prostate cancer present?
bone pain, weight loss advanced disease
LUTS
other than prostate cancer, what else increases PSA?
- Urinary retention
- UTI
- BPH
- DRE is negligible
what is the function of PSA?
a protease whose function is to break down the high molecular weight protein of the seminal coagulum into smaller polypeptides. This action results in the semen becoming more liquid.
what are the pros and cons for prostate cancer screening?
pros - screening reduces mortality
cons - significant over diagnosis and over treatment
when should you do a PSA?
in asymptomatic patient under 70 if they ask for it
in patient with LUTS, do PSA unless life expectancy less than 10 years and benign DRE
there are age specific PSA thresholds to help determine if it is high
why are trans uretheral ultrasound guided prostate biopsies not the perfect test?
can have significant adverse events, including sepsis, and negative biopsy doesn’t exclude cancer and if positive, may detect insignificant cancer which is over treated and can cause damaging side effects e.g incontinece and impotence
what is Gleason grading?
how adenocarcinoma prostate cancers are staged
on biopsy = sum of two highest scores found
on radical prostatectomy = two most prevalent scores
what is the difference between active surveillance and watchful waiting?
Active survelliance
- used for low risk disease
- monitor PSA/DRE 6 monthly
- aim of monitoring is to treat radically if disease progresses (and avoid unnecessary treatment if it doesn’t)
Watchful waiting
- older patients or with co morbidities
- aim of monitoring is palate treatment with hormones if develop mets or become symptomatic
what are the radical treatment options for localised prostate cancer and what are their adverse effects?
1) radical prostatectomy
side effects: incontinence, impotence. 10-15 life expectancy needed to justify.
2) external beam radiotherapy + hormones
side effects: bowel side effects, impotence
what are the treatments for metastatic disease?
1) androgen deprivation therapy
Bicalutamide (T receptor antagonist) used for 28 days then GnRH analogue injected after 14 days.
2) Early docetaxel chemotherapy - improves survival
what is the use of steroids in prostate cancer?
they are adrenal suppressors so less hormone released = less acting on prostate.
how can biopsies of the prostate be taken?
transperineal biopsy
transrectal US guided biopsy
