Prostate Cancer Flashcards
(21 cards)
What is the function of the prostate?
To make seminal fluid, which is stored in seminal vesicles
What is PSA?
It is a protein made by the prostate, found in the blood.
What can raise PSA levels?
BPH, cancer, prostatitis, enlargement of the prostate
How likely is a raised PSA to indicate cancer
1 in 3
What ethnic group are more likely to develop prostate cancer?
Afro-Caribbean
What two mutations may be associated with prostate cancer?
pTEN & BRCA-2
What is the most common type of prostate cancer (95%)
Adenocarcinoma
What may indicate cancer on DRE?
Prostate may be enlarged, hard, craggy, with obliteration of the median sulcus
What test should be requested if mets are suspected?
Isotope radionucleotide bone scan
What is the common pattern of bone mets in prostate cancer?
Sclerotic lesions
Axial pattern
Unlikely below knees & elbows
If PSA is elevated, what are the next steps for investigation?
PSA elevated
2 week referral to urology
Pre-biopsy MRI
Transrectal USS
What does TNM staging indicate?
The size & extent of a tumour
How does Gleason grading work?
Tumours scored from 2-13 on basis of cell differentiation in the two most dominant areas. Combined score (e.g. 4+3 = gleason 7)
When is observation a management option?
If asymptomatic & cancer is confined to the prostate
When will radical prostatectomy be considered?
In localised disease (T2 or less)
Good option for men age <70
What are two risks of radical surgery?
Lasting impotence & incontinence
What is the principle behind hormonal therapy for prostate cancer?
Inhibition of the growth-stimulatory effect of endogenous androgens
How do LHRH (leutinizing hormone-releasing hormone) agonists work?
What is a risk?
Interferes with release of gonadotrophins from the pituitary. Reduces levels of testosterone.
Risk of tumour flare
How does degarelix work and what is it?
Gonadotrophin-releasing hormone antagonist
Leads to castrate levels of testosterone in 3 days with no risk of tumour flare
When should brachytherapy be considered and when not?
Yes: fit men with no co-morbidities
Avoid in men with large prostates/ significant urinary symptoms
What is the mainstay of therapy for metastatic cancer?
Androgen deprivation therapy (ADT)
