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20 Cards in this Set

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What are the risk factors for adenocarcinoma of the prostate? (4)
1. Age: >50
2. Ethnic group: Blacks>Whites>Asian for gross cancer but all equal for latent, microscopic cancer
3. Environmental/dietary incluences
4. Hormones (androgens)
How does testosterone increase risk of developing prostate cancer?
Testosterone is converted to DHT by 5 alpha reductase. DHT also produced directly by prostate stromal cells. DHT acts on prostatic epithelial cells to promote cell growth and survival.
How does Androgen Receptor gene determine genetic predisposition to developing prostate cancer?
Number of CAG repeats in AR gene is inversely correlated with risk of prostate cancer.
How do prostate tumours keep growing when androgen supply has been blocked?
Mutations cause AR to be activated by other ligands or allows bypass of AR for gene prostate cell survival
What percentage of prostate cancer is familial (genetically inherited)?
10%
What gene mutations may play a role in prostate cancer? (germline, somatic)
Germline: BRCA2 - 20x increase in risk but is rare
Somatic: ETS-TMPRSS2 rearrangement, GSTP1 promoter (most common)
What can cause PSA to be elevated? (5)
Prostate cancer, BPH, prostatitis, ejaculation, instrumentation of the prostate gland
Is PSA more accurate at detecting early disease or at evaluating response to therapy?
Response to therapy
What are other possible biomarkers that can be used to detect prostate cancer besides PSA? (4)
ETS-TMPRSS2 fusion
EZH-2
AMACR
PCR3
From which cell type in the prostate does adenocarcinoma arise?
Glandular epithelial cells
What location in the prostate is cancer most likely to arise?
Posterior
What is the precursor lesion of adenocarcinoma of the prostate called?
Prostatic Intraepithelial Neoplasia
What are the Gleason Scoring patterns?
1 - Well circumscribed, well differentiated (can't see on core biopsy because need whole gland)
2. Small glands, well differentiated (can't see on core biopsy because need whole gland)
3. small glands, diffusely infiltrative
4. Merged glands, diffusely infiltrative
5. No identifiable glandular differentiation
How do you add up Gleason patterns to give a final score?
Number of primary pattern + number of the next highest pattern present in the sample
What gleason score is more treatable and which tends to be more advanced?
Treatable 6-7, Aggressive = 8-10
What evidence supports that High Grade Prostatic Intraepithelial Neoplasia is the precursor of Prostate cancer? (3)
1. Both predominate the peripheral zone
2. HGPIN ofen seen in proximity to cancer
3. HGPIN and cancer share many genetic alterations
What is the natural history of adenocarcinoma of the prostate? (4 possible fates)
1. Tumour remains microscopic (latent)
2. Tumore remains confined to prostate gland (localized)
3. Local spread of prostate cancer via blood, lymphatics and nerves, mainly to seminal vesicles and base of bladder
4. Lymphatic spread + Hematogenous spread primarily to bone
What is the tumour staging system for adenocarcinoma of the prostate?
T1: Clinically inapparent
T2: Palpable or visible on imaging + confined to gland
T3:Extension beyond gland
T4: Invasion into other structures (bladder, rectum, pelvic wall)
N: Regional lymph node metastases
M: Distant metastases
What are prognostic factors for adenocarcinoma of the prostate? (4)
Tumor grade (Gleason score), Pre-operative PSA
Tumour stage
Surgical margin status
What is the outcome of minimally invasive, locally advanced and metastatic disease?
Minimally invasive - excellent
Locally advanced - fair to good
Metastatic Disease - poor