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40 Cards in this Set
- Front
- Back
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What is the peak incidence for prostate cancer?
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Between the ages of 65-75
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What is the most common type of prostate cancer?
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Adenocarcinoma (95%)
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What zone of the prostate does the majority of cancer develop?
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The peripheral zone
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What are the risk factors for prostate cancer?
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Advancing Age
Race - African American men 50% higher risk Genetics Diet - High fat, low vegetable diet |
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How does prostate cancer present in the digital rectal exam?
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Hard, nodular, or asymmetrical enlargement
Areas of induration |
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Apart from the digital rectal exam, how does prostate cancer present?
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Elevated PSA
Urinary Symptoms - Urgency, Nocturia, Frequency, Hesitancy, Hematuria New onset erectile dysfunction Hematospermia Symptoms of Metastatic Disease - Lymphedema, Axial Bone Pain |
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This is best at detecting tumors in the posterior and lateral aspects of the prostate. This will only detect about 1.5-7% of prostate cancers and at this point most of them will be advanced.
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Digital Rectal Exam
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This is a glycoprotein secreted by benign and malignant prostate tissue. It is measured to detect prostate cancer and monitor Tx response and to detect recurrence.
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Prostate Specific Antigen (PSA)
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What are the causes of an elevated PSA?
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Benign Prostatic Hyperplasia
Prostate Cancer Prostatitis Perineal Trauma |
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Prostate cancer is most commonly detected by this?
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Elevated PSA
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50-70% of men with a PSA level of ? will have prostate cancer.
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>10ng/ml will have prostate cancer
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This is a rate of change of PSA over time, increase >0.75ng/ml per year is suggestive of prostate cancer. Increase >0.75ng/ml with a PSA between 4-10ng/ml then a full workup for prostate cancer is warrented.
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PSA Velocity PSAV
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This is a ration between the serum PSA value and volume of the prostate gland.
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PSA Density (PSAD)
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PSAD value of ? and PSA between 4-10ng/ml require further work up.
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>0.15
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This is high in benign disease and low in prostate cancer.
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Free PSA
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This is the gold standard for diagnosis of prostate cancer.
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Transrectal ultrasound Biopsy (TRUS)
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This is based on the two most common glandular patterns observed, the higher the score the worse the prognosis.
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The Gleason score to grade cancer, used in Transrectal Ultrasound
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How many samples are usually taken in a prostate biopsy?
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6-12
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General Population: Yearly DRE and PSA for men _____ with a _______?
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Yearly DRE and PSA for men older than 50 with a 10 year life expectancy
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High Risk Population: Yearly DRE and PSA at age __ for African American men and for other men with positive family history.
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45
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Guidelines:
DRE normal and PSA not performed |
Repeat DRE in one year
Discuss benefits and harm of PSA |
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Guidelines:
DRE Normal and PSA Normal |
Low Risk : Repeat DRE and PSA in one year
High Risk: Repeat at six months-one year plus PSAV, PSAD, Free PSA |
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Guidelines:
DRE abnormal and PSA Normal, Borderline or Positive |
Tansrectal Ultrasound with Biopsy
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Guidelines:
Normal DRE and PSA between 4 and 10ng/ml |
Discuss benefits and risks of TRUS biopsy
Age specific PSA, PSAV, PSAD, Free PSA - if free psa high and psa velocity low have a yearly follow up If free PSA low and velocity high-trus biopsy |
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If free PSA is high and PSA velocity is low what does this most likely mean?
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Benign Prostatic Hyperplasia
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Guidelines:
Normal DRE and PSA >10 |
TRUS biopsy
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When you are doing a positive prostate cancer work up what four things do you include.
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Labs
MRI Radionuclide Bone Scan Abdomen and Pelvic CT |
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The labs for positive prostate cancer work up include?
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Creatinine, Alkaline Phosphatase, Calcium
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This may be used to evaluate tumor and regional lymph nodes?
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MRI
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This is to detect spread beyond the prostate. It is not recommended for T1 and T2 cancer, PSA<10, Gleason Score <6
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Radionuclide Bone Scan
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Recommended if external beam radiation to be used or PSA >10, Gleason score >6 to check for positive lymph nodes
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Abdomen and Pelvic CT
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This is a grading system based 1-5 on the two most prevalent histological grade. The higher grade often determines the biologic behaviour.
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Gleason Grading System
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This system uses the following classification:
T1-tumor nonpalpable, cancer cells on biopsy T2-tumor palpable, cancer cells confined to prostate T3-tumor beyond the prostate capsule or into the seminal vesicles T4-Tumors fixed and have extended beyond the prostate to adjacent areas Lymph node spread Metastasis |
Tumor, Node, Metastasis Staging System (TNM)
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What are the five Tx options for prostate cancer?
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Observation
Radical Prostatectomy Radiation Therapy: External beam Internal beam Hormone Therapy Chemotherapy |
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What do you do if you elect observation as a Tx option?
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Periodic PSA evaluations
Only use this for selected patients |
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This is when the entire prostate is removed with surrounding tissue. Considered curative for local disease. Complications include incontinence, and erectile dysfunction.
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Radical Prostatectomy
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This may be used to treat cancer that is still confined to the gland or minimal capsular penetration. Used to reduce the size of the tumor prior to surgery - external beam, internal beam (brachytherapy)
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Radiation therapy
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This is when small radioactive pellets are inserted into the cancerous tissue of the prostate.
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Internal beam (brachytherapy)
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This is used to lower androgen levels and is considered adjunctive therapy.
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Hormone therapy
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This is an option for men with cancer spread beyond the prostate.
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Chemotherapy
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