Tumours of the Urinary System: Prostate Cancer Flashcards
(29 cards)
Between what ages is prostate cancer most prevalent?
Between men ages 50 and 70yrs
What is the aetiology and risk factors for prostate cancer?
• Age
• Race/Ethnicity: African or Afro-Caribbean men living in Western countries
• Geography: Northwest Europe/North America/Caribbean/ Australia
• Family history
- first degree relative 2x risk
- HPC1; BRCA1 & 2
What are McNeal’s Prostatic Zones?
- Transition zone
- Central zone
- Peripheral zone
- Anterior fibromuscular stroma
Which of the McNeal’s prostatic zones if palpable?
Transition zone and is area where 80% of cancers develop and therefore can be palpable
How does prostate cancer present and how is it diagnosed?
- Most asymptomatic
- Diagnosed through opportunistic PSA testing
- Diagnostic triad of PSA, DRE and TRUS-guided prostate biopsies
What are the presenting symptoms?
Locally invasive disease (not local disease) • Haematuria • Perineal and suprapubic pain • Impotence • Incontinence • Loin pain or anuria (obstruction of ureters) • Symptoms of renal failure • Haemospermia • Rectal symptoms including tenesmus
What are the presenting symptoms of metastatic prostate cancer?
Distant mets: • Bone pain or sciatica • Paraplegia (spinal cord compression) • Lymph node enlargement • Lymphoedema • Loin pain or anuria (ureter obstruction by lymph nodes)
Widespread mets:
• Lethargy (i.e. anaemia, uraemia)
• Weight loss and cachexia
What is the commonest mode of presentation for prostate cancer?
a. Frank haematuria
b. Asymptomatic (i.e. incidentally noted)
c. Acute urinary retention
d. Symptoms of benign prostatic enlargement and obstruction
e. Bone pain
Asymptomatic (i.e. incidentally noted)
Why is screening for prostate cancer not used?
Most cancers picked up by screening usually in very early stages -> leads to over-diagnosis and over-treatment
Targeted people useful to carry out PSA screening
What is used to avoid under-treatment of aggressive cancers (as screening not really used)?
Ad-hoc PSA testing
What is PSA?
- Kallikrein serine protease - liquifies semen
- Produced by glands of prostate - may leak into serum
- Normal serum range 0-4.0 ug/mL
- Half life in 2.2 days (repeat tests taken after 3 weeks)
What are the normal levels of PSA for different age groups?
Age-related range - Levels increase with age: • < 50 years : 2.5 is upper limit • 50-60 years : 3.5 is upper limit • 60-70 years : 4.5 is upper limit • >70 years : 6.5 is upper limit
What are conditions with cause elevations in PSA?
- UTI
- Chronic prostatitis
- Instrumentation (e.g. catheterisation)
- Physiological (e.g. ejaculation)
- Recent urological procedure
- BPH
- Prostate cancer
What grading system used to be used assess aggressiveness of a prostate tumour?
Gleason pathological grading system:
• Uses histological characteristics
• Grade 3-5
How do you work out the Gleason grading score?
The first number assigned is the grade that is most common in the tumour.
For example, if the Gleason score is written as 3+4=7, it means most of the tumour is grade 3 and less is grade 4, and they are added for a Gleason score of 7.
Highest score is 10 (as grade is from 3-5)
What is the new grading system used to grade prostate cancer?
ISUP grade (based on Gleason sum score
Describe the different ISUP grade groups
ISUP Gleason
1: 3+3=6
2: 3+4=7
3: 4+3=7
4: 8
5: 9 and 10
What are the different stages of prostate cancer?
For purposes of treatment and prognosis, useful to divide prostate cancer into 4 stages (TNM): • Localised stage • Locally advanced stage • Metastatic stage • Hormone refractory stage
What tests are used to stage localised prostate cancer?
- Digital rectal examination (local staging)
- PSA
- Transrectal US guided biopsies
- CT (regional and distant staging)
- MRI (local staging)
Describe T2 stage of prostate cancer
T2a: Tumour involves one-half of 1 side of the prostate.
T2b: Involves more than one-half of 1 side of the prostate but not both sides.
T2c: Tumour has grown into both sides of the prostate.
Describe T3 stage of prostate cancer
Tumour has grown outside the prostate and might have spread to the seminal vesicles
Describe T4 stage of prostate cancer
Spread into adjacent organs i.e. bladder, pubic bones
What is the treatment for localised prostate cancer?
Watchful waiting
Radiotherapy:
• External-beam
• Brachytherapy
Radical prostatectomy:
• Open
• Laparoscopic
• Robotic
Others under investigation:
• Cryotherapy
• Thermotherapy
What is the treatment of locally advanced prostate cancer?
- Watchful waiting
- Hormone therapy followed by surgery
- Hormone therapy followed by radiation
- Hormone therapy alone
- Intermitted hormone therapy (clinical research)
Hormonal therapy lowers production of testosterone
