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Prostatic Cancer - Coggle Diagram

- - - - Low risk localised cancer
      - Gleason 6
      - Age
      - ever expanding
    - - Avoids s/e of treatment
    - - Regular PSA + DRE
      - After 2yrs lesion on MRI - repeatMRI
    - - Based on STRATCANS Tier
  - - - Suitable for surgery
    - - You can do radiotherapy after if there is recurrence
    - - Surgical removal of the prostate gland and seminal vesicles +/- lymph nodes
      - Open, laparoscopic and robotic techniques
      - Oncologically equal
      - Robot: Shorter LOS, reduced blood transfusion
        Most common robotic procedure inn the world
    - - Incontinence
        Short term 40%
        Persistent 4%
      - Erectile dysfunction 50-80%
      - Know for consenting a pt in long / shorts ⭐
  - - - You can't do ado surgery after radiotherapy - adhesions etc
    - - External beam radiotherapy and brachytherapy
        
        Mainstay of treatment
        
        Given over 5 weeks
        
        Side effects
        
        Cystitis
        
        Proctitis
        
        Haematuria
        
        FAtigue
        
        Incontinence, erectile issues - less than surgery
        
        May have 6 months of hormones
        
        Brachytherapy
        
        Implantation of radiotherapy seeds within prostate for low / certain intermediate risk
      - IMRT - intensity modulated radiotherapy
  - - - STAMPEDE trial
        
        Multiarm, multistage
    - - Metastatic prostate cancer
      - Biochemical recurrence post treatment
    - - 1️⃣Docetaxel
      - 2️⃣ ADT - Abiraterone acetate (inhibits CYP17A1) or enzalutamide (androgen receptor antagonist )
  - - - Metastatic disease
    - - .Supress Secrestion of Testicular Androgens
      - Lutenising hormone releasing hormone agonsits : Leuprorelin
      - Lutenising hormone releasing hormone antagonists: Degarelix
  - - - Patients not suitable for any curative therapy
- - - - Take 2 off their decade - in their 50: >3, in their 70s: >5
    - - <50y/o → 2ng/ml
        
        50-59 → 3ng/ml
        
        60-69 → 4ng/ml
        
        70 → 5ng/ml
    - - Refer if > 3ng/ml
  - - - Any irregular DRE regardless of exam
    - - Hard
      - Craggy
      - Nodular
    - - Inter and intra observer variability ~ 17%
  - - - PIRADS - Prostate Imaging Reporting and Data System
  - - - Transrectal (TRUS)
        Significant complication rates with TRUS - 10% risk of infx and increased risk of sepsis
      - Transperineal (TP biopsy)
    - - PIRADS lesion on MRI
      - High PSA density 📜 0.15
- - - - LA block to NVB of prostate
      - 6 samples from each lobe
        Base
        Mid
        Apex
      - No benefit in taking more biopsies
    - - 10 infx, 1% of them sepsis
      - Haematura / Haematosprmia / Blood PR
      - Transient LUTS
  - - - LA or GA freehand or using grid
      - Allows for saturation biospy (up to 40)
    - - Near 0% sepsis
      - Slight increase in AUR rates
    - - Needs additional training and infrastructure
- - - - Gleason score 6
        
        5%
    - - Gleason score 3+4 = 7
        
        17%
    - - Gleason score 4+3=7
        
        35%
    - - Gleason score 4+$=8
        
        37%
    - - Gleason score 9-10
        
        76%
- - - - Conservative MC
        
        PFMT
        
        Compression device
        
        Lifestyle changes
      - Surgery
        
        ARtificial urinary sphincter
    - - PDE5 inhibitors (daily or PRN)
      - Vacuum pump
      - Alprostadil (intraurethral or intracavernosal)
      - Surgery - penile prosthesis (inflatable vs malleable)