11.2: Male genital tract tumours Flashcards
What are the three main tumours that occur in the male genital tract?
- Prostate adenocarcinoma
- Penis squamous cell carcinoma
- Testis germ cell tumours
Name the three zones of the prostate, identify the zones most commonly affected by cancer and benign hyperplasia. Which zones are able to squeeze the urethra when enlarged?
- Central: Directly surrounds the urethra but is only affected by prostatitis and issues with the urethra
- Peripheral: major site of prostatic cancer - squeezes the urethra
- Transitional: the site at which most benign prostatic hyperplasia originates - invades outside before squeezing the urethra
What are corpora amylaceae? Are they pathological?
Aggregations of prostatic secretions, no pathology
Describe the histology of the prostate and how it changes in cancer
- Double layer epithelium: inner secretory which makes PSA (prostate specific antigen), and outer basal cells
* this 2-layer morphology is lost in cancer and usually just a lining of single cells remains with bigger nuclei - Outer limiting BM: cancerous invading cells will breach this layer and invade into the fibromuscular stroma
Who is at risk of benign prostate hyperplasia?
> 50 years, more likely to experience symptoms if there is FH, black African race, changing hormonal levels
What are the symptoms, signs and complications of benign prostatic hyperplasia (BPH)?
Urethral obstruction which leads to infection. This can cause increased frequency and urinary retention
As BPH advances the bladder may undergo dilatation and hypertrophy, and bladder diverticula may form (outpuchings of urethelium into and sometimes outside the bladder wall)
Obstructed urine can generate stones which can also develop inside the diverticula, these are very painful.
Upstream, the increased pressure in the bladder causes ureter dilation and a sigmoid shape - the increased pressure is transmitted to the kidney (hydronephrosis), and can eventually lead to renal failure
How is BPH managed?
*Include the two types of ‘operations’, identify which is the ‘golden standard’ and briefly describe it
Prostate resection: this opens up the urethra and relieves the damage and symptoms
- Open operation: removal of whole gland
- Golden standard: Trans urethral resection of prostate (TURP): a uroscope with a cutting edge is passed through the penis and urethra into the gland and chips away at the prostate until the passage is clear - these chips are sent to the histopathology department so they can be examined for cancer
Name four risk factors for prostate cancer
- Linear with age (the younger the age at presentation, the more aggressive the disease)
- African-american men
- FH
- Possibly diet
What are the important signs and symptoms in early and advanced prostate cancer?
Early: asymptomatic
Advanced: frequent and difficult (starting or stopping) urinating, decreased force of urination. Blood in semen and urine, pain or discomfort in the pelvic area
What symptom can indicate metastasis of prostate cancer?
Bone pain
Where will prostate cancer invade to locally and systemically (and what happens as a consequence of this)?
Locally: seminal vesicles and bladder base
Bones: axial skeleton/vertebrae which becomes osteoblastic (thickened and hardened) as the cancer spreads, increasing the risk of fracture and causing back pain. Some visceral dissemination
If prostate cancer is suspected clinically or as a result of a PSA screening test, what is the standard procedure to make a diagnosis?
The tumour begins in the outer part of the gland and is therefore palpable in a DRE; cancer tissue will feel hard, irregular and gritty.
Trans-rectal biopsies are also done to attain multiple core samples
How is grading of prostatic tumours assessed?
The Gleason’s pattern scale: a 5 point scale that reflects how differentiated the cancerous tissue is from normal tissue: 1 well differentiated - 5 anaplastic
How is the TNM staging applied to prostate cancer?
T: Tumour 1 - incidental finding 2 - confined to prostate 3 - extends outside 4 - direct invasion of contiguous organs
N: nodal invasion (0 or 1; usually of pelvic lymph nodes)
M: metastasis
How is prostate cancer managed and how has this changed over the years? How is it followed up?
Management is controversial and evolving: many were formerly not treated as it wasn’t believed it would make much of a difference in their life span
Nowadays, treatment is more dependent on the stage and grade and can involve…
- Doing nothing
- Surgical: Prostatectomy: open or laparoscopic
Non surgical
- radiotherapy: prostate carcinomas are somewhat radio sensitive
- Hormone therapy: suppress the hormone supporting the multiplication of cancer cells with another hormone (i.e estrogen) to slow the spread
Followed up with blood PSA levels
