Week 6: Prostate cancer

Question 1

What is the median age of dx for testicular cancer?

Answer 1

-32yr
-Patients get this confused with prostate
-Being born with undescended testicle=risk factor
-No well-established hereditary cancer syndromes
-Important to know so can differentiate from prostate pts get confused

Question 2

Brief overview/info about the prostate

Answer 2

-Exocrine gland of the male reproductive system
-Produces fluid for semen and helps expel semen
-Typically walnut-ping pong ball size

Question 3

What is benign prostatic hyperplasia (BPH)? Is this related to prostate cancer?

Answer 3

-Enlargement of the prostate
-Common with aging
-NOT cancer, but may be mentioned in cancer history as “enlarged prostate”
-Symptoms include: frequent/urgent urination, peeing more often at night, not being able to fully empty bladder, etc

Question 4

What is the median age of diagnosis for prostate cancer?

Answer 4

67yr

~12.9% of men will be dx with prostate cancer in lifetime (comparable to breast ca in women)

Question 5

Generally, what is the 5yr survival rate like for prostate cancer? Any racial backgrounds more heavily affected than others?

Answer 5

-5yr survival pretty good
-Prostate cancer generally slow growing and doesn’t metastasize
-Higher incidence in Black population

Question 6

T/F All patients with prostate cancer require treatment

Answer 6

False! Some cancers are slow growing and stay localized so they can just be monitored

Question 7

Name some pros of PSA screening

Answer 7

-May help detect cancer early
-Prostate ca easier to treat and more curable if dx early
-Simple, widely used blood test
-Number of deaths from prostate cancer has declined since PSA testing available

Question 8

Name some cons of PSA screening

Answer 8

-Some prostate cancers are slow growing and don’t metastasize
-Not all prostate cancer needs treatment, risks
-False positives and negatives
-Can provoke anxiety

Question 9

What is PSA?

Answer 9

-Prostate specific antigen
-PSA is a glycoprotein secreted by prostatic epithelial cells
-PSA enters circulation
-If abnormally high PSA observed, repeat testing should be performed

Question 10

Can prostate cancer be diagnosed with PSA?

Answer 10

No! Biopsy!!

Question 11

T/F PSA is a reliable, specific marker for prostate cancer

Answer 11

False, PSA is not a cancer specific marker and elevated PSA can be due to other things. Most individuals with elevated PSA levels don’t have cancer

Question 12

What is a Gleason pattern? Gleason score?

Answer 12

-Pathologist examines biopsy for most common and second most common Gleason patterns
-The two patterns are combined to get the Gleason score (ex: pattern 3+ pattern 4 = Gleason score 7)
-Higher pattern #=less differentiated cells

Question 13

Tumors with Gleason scores 8-10 are typically well differentiated or tend to be more advanced?

Answer 13

scores 8-10 tend to be advanced, aggressive neoplasms that are less likely to be cured

Question 14

How does the risk for prostate cancer associated with a variant in BRCA1 compare to the risk for variant in BRCA2?

Answer 14

Risk for prostate cancer much higher for BRCA2 variant

Question 15

BRCA2 carriers are recommended to start screening for prostate cancer at what age?

Answer 15

40yrs

Consider prostate cancer screening for BRCA1 carriers

Question 16

A pathogenic germline variant is identified approximately what percent of the time in prostate cancer cases?

Answer 16

12-17%

Question 17

Variant G84E in HOXB13 is associated with what?

Answer 17

-3-6x higher chance to be diagnosed with prostate cancer
-Found pretty much exclusively in white population, absent in Black

Question 18

Variant X285K in HOXB13 is associated with what?

Answer 18

-2.4-fold increase in prostate cancer
-Greater risk for aggressive and advanced disease
-Primarily in Black population

Question 19

3 clues for familial prostate cancer?

Answer 19

1. 3+ affected men in nuclear family
2. Affected men in three vertical generations
3. Two men in family diagnosed <55yr

Question 20

Describe the 3 classifications for prostate cancer treatment

Answer 20

1. Active surveillance
2. Local treatment
   -Surgery: prostatectomy, removal of testicles, TURP
   -Radiation: external beam, brachytherapy
3. Systemic treatment
   -Androgen deprivation therapy
   -PARP inhibitors (BIG for BRCA+)
   -Chemo
   -Immunotherapy