Flashcards in Urology - Prostate Cancer Deck (14)
Loading flashcards...
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