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Oncology + Palliative > Prostate Cancer > Flashcards

Flashcards in Prostate Cancer Deck (20):

Grading system

Gleason grades for 2 predominant patterns in biopsy + add to get

Gleason score 1 = small uniform glands

2 = more stroma between glands

3 = distinctly infiltrative margins

4 = irregular masses of neoplastic glands

5 = only occasional gland formation


TNM staging used

T1: Clinically inapparent tumour. Found during surgery for other reasons or on biopsy after raised PSA.

T2: Confined within prostate (can be on one half, over one half or in both halves

T3: Tumour extends through the prostatic capsule (type b to seminal vesicles)

T4: Tumour is fixed or invades adjacent structures (e.g. e back passage, bladder, or the pelvic wall)

N1: regional lymph node mets

M1: distant mets (a lymph b bone c other)


What is the most common form of prostate cancer?

Usually adenocarcinomas arising in glandular tissue in posterior or peripheral prostate



Most common cancer in men 1 in 8 80% in >80y/o



Increasing age

Black Afro-caribbean

Fam hx (double chance if 1st degree family member)

High testosterone

Anabolic steroids

BRCA2 gene



Weak stream, hesitancy, sensation of incomplete emptying, urinary frequency, urgency, urge incontinence UTI, raised PSA

1 in 5 present with mets - may have bone complications like anaemia, pain, fractures or spinal cord compression


Metastatic disease symptoms (prostate)

Bone pain/ sciatica

Paraplegia (2' to spinal cord compression)

Lymph node enlargement 

Palpable seminal vesicles


PR examination findings

Asymmetry, nodule with one lobe, induration of prostate, lack of mobility, palpable seminal vesicles Enlarged, craggy, hard gland Obliteration of median sulcus


Common mets

Seminal vesicles, bladder, rectum, sclerotic bone lesions

Lungs + liver



UTI, obstruction BPH Prostatitis Bladder tumours



PSA - good for treatment monitoring

Trans-rectal US biopsy

MRI for staging + management Isotope bone scan


5 year survival rates for each stage

Stages 1-2 = 99% 

Stage 3 = 95% 

Stage 4 = 30% 


Management options for early stage prostate cancer 

Radical prostatectomy

Radical radiotherapy (+neo/adjuvant hormonal therapy) = good for men with comorbidities

Brachytherapy = good for fit men

Hormone therapy alone - temporarily delays tumour progression - consider for elderly, unfit patients with high risk disease


Describe hormone treatment - how long, what are the options?

Hormonal drugs for 1-2 years 

1st: LHRH agonists (12 weekly gosrelin SC)

2nd: LHRH antagonist degarelix (3 weekly)

3rd: Non steroidal anti androgens (abiaterone) 


Risks of surgery, RT, androgen deprivation therapy, brachytherapy

Surgery = risks of long term incontinence and impotence

RT = long term risk of bowel problems, dysuria, rectal bleeding, impotence + incontinence

Androgen deprivation therapy = hot flushes, sexual dysfunction, lost muscle bulk, memory effects, weight gain, DM, osteoporosis

Brachytherapy = urinary symptoms 


How do LHRH agonists work?

LHRH agonist sits in LHRH receptors in pituitary

Pituitary releases LH which stimulates testes to produce testosterone

Initially increases testosterone then reduces level of testosterone


SE of LHRH use

Impotence, loss of libido + tumour flare initially - risk in spinal cord compression

Tumour flare avoided with anti-androgen therapy

Long term: cardiac risk + osteoporosis


Gonadotrophin releasing hormone (LHRH) antagonist use + when treatment is given 

Lowers levels of testosterone within 3 days

No risk of tumour flare

Monthly SC injection Used when MSCC is a risk


10 year survival rate



How do mets spread to the bone?

Via Batson's venous plexus