Urology - Prostate Cancer Flashcards Preview

Year 3- Surgery > Urology - Prostate Cancer > Flashcards

Flashcards in Urology - Prostate Cancer Deck (14)
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1
Q

Epidemiology

A
  • Commonest male Ca
  • 3rd commonest cause of male Ca death
  • 80% of men over 80 have some form of it
2
Q

Pathology

A

-Adenocarcinoma in the peripheral zone of prostate

3
Q

Patient presentation

A
  • usually asymptomatic
  • Urinary: nocturia, frequency, hesitancy, poor stream, terminal dribbling and obstruction
  • Systemic: wt loss, fatigue
  • Mets: bone pain
4
Q

Pr examination - notable findings

A
  • Hard/irregular prostate on PR

- Loss of midline sulcus

5
Q

Potential routes of spread

A
  • Local: seminal vesicles, bladder, rectum
  • Lymph para-aortic nodes
  • Haem: sclerotic bone lesions
6
Q

Ix

A
  • Bloods: PSA, FBC, U+E, uric acid, alp phos, Ca markers
  • Imaging: XR chest and spine, transrectal US + biopsy, bone scan, staging MRI (contrast enhances detection of affected nodes)
7
Q

What is the name of the scale used to grade prostate cancer?

A

-Gleason score

8
Q

Outline the TNM classification for prostate cancer

A
  • T is: carcinoma in situ
  • T1: incidental finding on TURP or raised PSA
  • T2: intracapsular tumour with deformation of prostate
  • T3: extra-prostatic extension
  • T4: fixed to pelvis + invading neighbouring structures
  • N1-4: 1 or more lymph nodes involved
  • M1: distant mets (eg spine)
9
Q

Mx- general principles

A
  • Difficult to know which tumours are indolent and which will never cause problems
  • Radical therapy is associated with significant morbidity :(
10
Q

Mx: conservative

A

-Active monitoring with PSA and DRE

11
Q

Localised prostate cancer (T1/T2) rx

A

Rx depends on life expectancy and pt choice. Options:

  • Conservative: DRE/PSA active monitoring and watchful waiting
  • radical prostatectomy
  • radiotherapy: external beam and brachytherapy
12
Q

Localised advanced prostate cancer (T3/T4)

A

Options include:

  • Hormonal therapy (next slide)
  • radical prostatectomy
  • radiotherapy: external beam and brachytherapy
13
Q

Metastatic prostate cancer disease- hormonal therapy

A

Synthetic GnRH agonist

  • Eg Goserelin (Zoladex)
  • Cover initially with anti-androgen to prevent rise in testosterone

Anti androgen
-Cyproterone acetate prevents DHT from binding to intracytoplasmic protein complexes

14
Q

Mx: symptom relief

A
  • TURP for obstruction
  • Analgesia
  • Radiotherapy for bone mets/chord compression

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