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18 Cards in this Set
- Front
- Back
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What is the lifetime probably of getting prostate cancer?
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1 in 6
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How much has mortality due to prostate cancer been reduced in the past 10 years?
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25%
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What are risk factors for prostate cancer? (3)
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Race (increased in African American, decreased in Asian)
Family History Diet - high fat intake, low vit D, Vit. E etc. O |
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Does the environment play a big role in BPH progression to prostate cancer?
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Yes - when people move from country of low rates to country with high rights their risk increases alot
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What are 3 strategies to reduce mortality from prostate cancer?
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Prevention
Earlier detection Improved therapies |
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How do you prevent the development of prostate cancer? (4)
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Nutrition: low fat, high soy
Micronutrients: Vit. E, D, selenium Supplements: lycopenes Hormones: 5 alpha reductase inhibitors |
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What is prostate specific antigen, where does it come from and how is it regulated?
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PSA is a glycoprotein produced by prostate epithelial cells that is responsible for liquefaction of seminal coagulum and is androgen regulated
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What makes prostate cancer a suitable cancer for screening?
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1. Cause of substantial morbidity/mortality
2. High prevalence of pre-clinical state 3. Screening test with high sensitivity low cost and convenient (PSA+DRE+history) 4. Mortality reduction due to earlier detection (ie-improved treatment) |
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What causes high PSA that is NOT cancer? (false positives) (4)
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BPH
Prostatitis Inflammation Manipulation |
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What are the advantages and disadvantages of screening for prostate cancer?
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Advantages - mortality reduction, improved curability, simple/inexpensive, NNT comparable to breast
Disadvantages - Imperfect, risk of overdiagnosis/overtreatment |
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How do you screen for prostate cancer using PSA?
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Baseline PSA at age 40
q 5 years from 40 to 50 q 1-2 years from 50 to 70 |
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What are the 4 stages of local prostate tumor growth, which are localized vs advanced and what screening tests can detect each?
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T1 - Localized, PSA only
T2 - Localized, PSA and DRE T3 - Locally advanced, PSA and DRE T4 - Locally advanced, PSA and DRE |
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Is Gleason Score a good predictor of outcome from prostate cancer? Can it be used to help decide on treatment?
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Yes and Yes
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How do you calculated Gleason score?
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Take biopsy and make histology slide
View tissue under low power magnification Score the pattern(s) of cells seen from 1-5 Add scores from the first and second most common patterns |
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What are treatment options for localized prostate cancer? (5)
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1. Active surveillance
2. Radical prostatectomy (open, laproscopic, robotic) - most common treatment in young, healthy patients. Most definitive treatment with acceptable side effects. 3. Brachytherapy - good cure rate for early disease and has less side effects than external beam. 4. External Beam Irradiation - most effective treatment for locally advanced disease. High morbidity and proctatitis in 10-15 years so only use on older patients 5. Image Guided Minimally invasive - Cryosurgery: not very effective with similar morbidity. High intensity focused U/S: non-invasive and precise but data lacking |
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What are 3 methods to achieve androgen deprivation?
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1. Surgical castration
2. LHRH analogues (mainstay): injections, reversible but can have "flare". Act by negative feedback. 3. Anti-androgens: less effective, oral, can cause gynecomastia when used alone |
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What are indications for androgen deprivation therapy? (4)
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1. Metastatic prostate cancer
2. Lymph node metastasis 3. Adjuvant after radiation in intermediate-high risk patient 4. Rising PSA after definitive local therapy |
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What are adverse effects associated with androgen deprivation therapy? (6)
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Metabolic syndrome
Loss of bone mineral density Hot flashes Decreased energy Cognitive/personality changes |
