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Y3M - Urology > Prostate Cancer > Flashcards

Flashcards in Prostate Cancer Deck (36)
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1

Epidemiology

Most common cancer in men in the UK

26% of all male cancer diagnoses

2

Pathophysiology

Unclear

Widely agreed that growth of prostate cancer is influenced by androgens like testosterone and DHT

3

Type of prostate cancer

>95% are adenocarcinomas

Over 75% of prostate adenocarcinomas arise from the peripheral zone

20% from the transitional zone

5% in the central zone

Prostate cancers are often multifocal

4

Subtypes of prostate adenocarcinomas

Acinar adenocarcinoma originating in the glandular cells that line the prostate and is the most common form

Ductal adenocarcinoma that comes from cell lining of the duct. They tend to grow and metastasis faster.

5

Risk factors

Age

Ethnicity - Black african or Carribean ethnicity twice as likely.

FH of prostate cancer

BRCA2 or BRCA1 gene

Obesity, DM, smoking, degree of exercise

6

Clinical features

Usually presents with LUTS with a weak urinary stream, increased urinary frequency and urgency.

More advanced localised disease can also cause haemturia, dysuria, incontinence, haematospermia, suprapubic pain, loin pain and even rectal tenesmus.

Metastatic disease can also cause bone pain, lethargy, anorexia and  unexplained wieght loss

7

Examinations

DRE is essential

Most arise from posterior peripheral zone so check for asymmetry, nodularity or fixed irregular mass.

8

Dx

BPH

Prostatitis

Bladder cancer, urinary stones, UTI and pyelonephritis

9

Lab test

PSA

A serum protein produced both by malignant and normal healthy cells in the prostate which can be elevated

10

When else might PSA be elevated?

BPH

Prostatitis

Vigorous exercise

Ejaculation

Recent DRE

11

Further calculations using PSA

Free:Total PSA ratio

A low ratio is associated with increased chance of diagnosig prostate cancer

 

12

Explain PSA density

Serum PSA level divided by the prostate volume which is determined on imaging.

High PSA densitiies = increased likelihood of prostate cancer

13

Further investigations

Current standard method for diagnosis is through biopsies of prostatic tissue

14

Potential methods of biopsy

Transperineal Template Biopsy

TransRectal Ultrasound guided (TRUS) biopsy

15

Explain Transperineal Template Biopsy

Sampling of biopsy transperineally.

This is done as a day case under general anaesthetics.

Transperineal approach allows for better access to the anterior part of the prostate and has a lower risk of infection.

16

Explain TransRectal UltraSound-guided TRUS biopsy

Sampling transrectally under local anaesthetics

12 cores are taken bilaterally in equal distribution from base to apex

1-2 % risk of sepsis.

 

 

 

Repeat prostate biopsy after previous negative biopse is recommended if there is a rise in PSA or peristently elevated.

17

What grading system is used for prostate cancer?

Gleason Grading System

18

Explain Gleason Grading System

Sample is assigned a score according to differentiation

Score is then calculated as the sum of the most common growth pattern + the second most common growth pattern seen.

Higher score = Less favourable prognosis

19

Imaging in prostate cancer

Multiparametic magnetic resonance imaging mp-MRI is increasinly used to aid diagnosis.
It can identify abnormal areas which can then be targetted for biopsy by MRI-ultrasound fusion or cognitive-guidance techniques.

 

This means that mp-MRI is sometimes being used earlier in the diagnostic pathway prior to initial biopsy.

 

20

When is staging of prostate cancer done?

Staging is typically done in intermediate and high-risk disease via CT-abdo-pelvic scan and bone scan.

21

General management

Specialist prostate cancer MDT meeting

PSA levels, Gleason score and T staging decides further management.

22

Low risk disease management

Active surveillance

Radical treatment only offered to those who show evidence of disease progression

23

Intermediate and high risk management

Radical treatment options should be discussed.

Intermediate risk can also be offered active surveillane.

24

Metastatic disease management

Chemotherapy agents and anti-hormonal agents

25

Castrate-resistant disease management (Hormone-relapse prostate cancer)

Further chemotherapy like Docetaxel.

Corticosteroids can also be given as third line after androgen deprivation therapy and anti-androgen therapy.

26

Explain the Watchful waiting and active surveillance management.

Symptom guided approach

Monitoring of patients with 3-monthly PSA

6 month to yearly DRE

Re-biopsy at 1-3 yearly intervals assessing for progression

mpMRI is also being used.

27

Surgical management

Radical prostatectomy removing prostate gland, resection of the seminal vesicles + any surrounding tissue.

This can be done open approach, laparoscopically or robotically

28

Complications of prostatectomy

ED

Stress incontinence

Bladder neck stenosis

29

When is radiotherapy done?

External-beam radiotherapy and brachytherapy are both commonly used as alternatives to curative intervention of localised prostate cancer.

30

Explain brachytherapy

Transperineal implantation of radioactive seeds of Iodine-125 directly into prostate gland