what are the three zones of the prostate?
central
transitional
peripheral
in what zone do most prostate cancers occur?
peripheral (70%)
what staging does prostate cancer use?
TNM
how many T stages of prostate cancer is there?
4: 1 2a/b/c 3a/b 4
what is stage T1 of prostate cancer ?
normal DRE but + on biopsy
what is stage T2a of prostate cancer ?
palpated on DRE and in 1/2 of one lobe
what is stage T2b of prostate cancer ?
palpated on DRE and in >1/2 of one lobe
what is stage T2c of prostate cancer ?
palpated on DRE and in both lobes
what is stage T3a of prostate cancer ?
through the prostate capsule
what is stage T3b of prostate cancer ?
invaded the seminal vesicles
what is stage T4 of prostate cancer ?
metastatic
what chemical is used as a non specific marker for prostate cancer?
PSA (prostate specific antigen)
what is the action of PSA?
luminal cells release PSA to help liquefy the semen after ejaculation
what hormones does the luminal cells rely on?
testesterone
androstenedione
dehydroepiandrosterone
dihydrotestosterone
what are normal PSA levels for <60yrs, 60-70yrs and >70yrs ?
<60yrs = <3 60-70yrs = <4 >70yrs = <5
what factors increase PSA levels?
age BPH prostatitis UTI biopsy catherisation prostate cancer
what factors decrease PSA levels?
ejactulation
prostatectomy
hormonal therapy (5alpha reductase inhibitors)
what is the name of the histology grading of prostate cancer?
gleason grading
state some storage symptoms ?
frequency
nocturia
urgency
urge incontience
state some voiding symptoms ?
poor urinary flow hesitancy straining intermittency incomplete emptying
what two investigations could be done for prostate urianry symptoms?
international prostate symptoms score (IPSS)
uroflowmetry
what should the Qmax be below for uroflowmetry to suggest obstruction?
<10ml/sec
what active treatment is available for prostate cancer?
active surveillance wait and watch radical prostatectomy radical RT brachytherapy
what is a benefit of active surveillance and wait and watch
avoid toxity side effects of treatments
what is a con of active surveillance ?
psychological difficulties
risk of significant progression
what is a con of wait and watch?
potential complications (spinal cord compression)
suitable for older males with low grade tumours
what is a disadvantage of radical RT?
risk of rectal damage
risk of obstructive symptoms
risk of impotence
what is a disadvantage of radical prostatectomy ?
risk of impotence
not suitable for patients with co morbidities
what is a disadvantage of bradytherapy?
risk of worsening obstructive symptoms
radiation protection issues for family
what palliative treatments are available ?
hormonal therapy
chemo
biologics
bisphosphonates
RT
TURP
as well as PSA what other marker may suggest prostate cancer?
Acid phosphatases
what genes are associated with FHx prostate cancer?
BRCA1/2
HPC1 and PCAP on Chr 1
is prostate cancer incidence increasing or decreasing ?
increasing
what race is most affected by prostate cancer?
afro caribbeans
what symptoms may locally advanced prostate cancer have?
haematuria
obstruction
what investigations can be done for prostate cancer?
DRE PSA, FBC TRUS and biopsy MRI pelvis isotope bone scan
how many samples are usually taken for prostate biopsy?
8
what gleason score is the cut off for low and high risk cancer?
<7 = low risk 7 = intermediate risk >7 = high risk
what are some arguments against prostate cancer screening?
diagnostic test (TRUS) is invasive
no impact on prostate cancer mortality
impact on cancer services
curative therapies carry significant morbidity