Prostate Cancer Flashcards
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
Epidemiology
Most common cancer in men 1 in 8 80% in >80y/o
RF
Increasing age
Black Afro-caribbean
Fam hx (double chance if 1st degree family member)
High testosterone
Anabolic steroids
BRCA2 gene
S+S
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
Differentials
UTI, obstruction BPH Prostatitis Bladder tumours
Investigations
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
How do mets spread to the bone?
Via Batson’s venous plexus
