What are the 2 main components of "lower urinary tract syndrome"?
1. mechanical obstruction
2. neurogenic
What are the options for treating BPH?
Removal of prostate tissue: TURP (transurethral resection of prostate), Suprapubic prostatectomy Androgen blockade
Inhibition of alpha-adrenergic enervation
What are some side effects of trans-urethral resection of the prostate (TURP)?
Side effects:
stricture
bleeding
incontinence
impotence
15 % develop symptoms requiring another TURP within 10 years
What are some risk factors for prostate cancer?
Older age
Intact hypothalamic-pituitary-testis axis
African-Americans have prostate cancer at a younger age and higher rate than whites.
Incidence increases 5-fold in Japanese who emigrate to the USA
family history of prostate, breast or brain cancer.
A set of prostate biopsies showed prostate adenocarcinoma. What additional information provided in the biopsy is useful for deciding how to manage this patient’s cancer?
The grade of the cancer: Grading is based on how well-formed the glands are (the Gleason system).
Using the Partin tables, the grade, serum PSA and the clinical stage the probability of the cancer being confined to the prostate can be determined.
What is a "grade" of cancer?
Grade = How well differentiated a tumor is
How closely tumor histologically resembles non-tumor, normal cells of that organ:
Low-grade = Close resemblance
High- grade = Little resemblance
What is meant by a "stage" of cancer?
Stage = Where the tumor is at time of diagnosis
Localized = Tumor is confined to the organ of origin
Regional spread = Tumor has invaded adjacent organs
Metastatic = Discontinuous spread of tumor to other tissues
What is the lowest score on the Gleason cancer grading system? highest score?
lowest score: 2 (1 + 1)
highest score: 10 (5 + 5)
What are the advantages and limitations of different options for treating a primary prostate cancer?
Choices of therapy:
Radical prostatectomy
Radiation therapy (Implantation of radioactive seeds (brachytherapy))
External beam
Hormonal blockade
Watchful waiting/active surveillance
Side effects:
Incontinence
Impotence
Fissures
Strictures
Loss of libido
Osteoporosis
What are the eligibility requirements for having an "active surveillance" approach to prostate cancer treatement? What is "active surveillance"?
Eligibility:
clinical stage T1
PSA level ≤ 20 ng/mL
Gleason score < 7
PSA measured and a DRE conducted at 3-6 month intervals.
Decision between continued monitoring or definitive therapy is informed by rate of rise of PSA and patient - clinician decision
80% of patients still on active surveillance at 10 yrs.
Which organ does metastatic prostate cancer preferentially affect?
Prostate cancer has high proclivity for bone; these metastases are usually osteoblastic and the source of marked pain.
The majority of patients who die of prostate cancer have widespread bone metastases
100% of bone metastases invasion in the right iliac decreasing slightly throughout the spine and the thoracic cage to 64% in the left humerus.
Some men whose cancers have been retarded by androgen deprivation therapy present later with metastatic cancer. What is the mechanism for prostate cancer progression in these cases?
Presumably, the selection for prostate cancer cells that don’t depend on androgen receptor activation for proliferation.
There is evidence that prostate cancer cells can produce sufficient androgen to activate androgen-dependent pathways
True/False: The majority of patients with prostate cancer die from the disease.
False
Only a minority of patients develop progressive tumor
Only a minority of these patients die of prostate cancer
The majority die of cardiovascular disease
How will you screen a patient for prostate carcinoma and what is the effectiveness of these screening method(s)?
Screening techniques:
Digital rectal exam (DRE)
Serum PSA
Efficacy:
DRE is insensitive and relatively nonspecific
Specificity and sensitivity of serum PSA for detecting prostate cancer is low
Prevention:
Diet5 alpha reductase blockade, i.e. finasteride
Is serum PSA a good screening assay for detecting primary prostate cancer?
No
Serum PSA “measures” the size of the prostate regardless of whether there is cancer (either low- or high-grade)
True/False: Routine PSA exams are recommended for people over the age of 75.
False
P.S.A. screening is currently not advised for those 75 and older.
What are the 4 basic medications that affect the androgen pathway and are used to prevent/treat prostate cancer? What are the common side effects of these drugs?
1. estrogens (prevent LHRH release from hypothalamus)
