8: Prostate and bladder cancer Flashcards
Where is the prostate gland found in relation to the bladder?
Neck of the bladder
What part of the urethra is surrounded by the prostate gland?
Prostatic urethra
What are zones of the prostate?
Central zone - where benign cancers arise
Peripheral zone - where malignant cancers arise
From which zones of the prostate do
a) BPH
b) prostate cancer
develop?
a) Transitional zone
b) Peripheral zones
What is the most common cancer found in men in the UK?
Prostate cancer
What are the investigations for prostate cancer?
PR exam - hard, full prostate
PSA - blood test, marker for prostate activity
Biopsy
Prostate cancers are either well or poorly ___ on biopsy.
differentiated
poorly differentiated is bad
What is unique about the appearance of prostate cancer?
Multiple different morphologies can be found in the same cancer
Which system is used to grade prostate cancer?
Gleason’s scoring
adding together the two most frequent patterns to get a score out of 10
In terms of staging, T1 describes __-__ cancers.
non-palpable
so detected by PSA
What is a T2 prostate cancer?
Palpable
What is a T3+ prostate cancer?
Found outside the prostate
Where does prostate cancer most commonly spread?
Bone
Lymph nodes
Metastatic prostate cancer spreads where?
Bones
Lymph nodes
What are two investigations used to check for prostate cancer spread?
Bone scan
MRI scan - to see if it has spread outwith the capsule
Summarise the investigations for
a) localised
b) metastatic
prostate cancer.
a) PR exam, PSA, biopsy (giving Gleason score)
b) Bone scan, MRI
Depending on investigation results, prostate cancer is given a ___ of invasion.
risk
How is low-risk, localised prostate cancer managed?
Monitoring
How is intermediate to high risk, localised prostate cancer treated?
Prostatectomy - open or laparoscopic
Radiotherapy
What is a possible side effect of prostate surgery in men?
Infertility
Which hormone stimulates the prostate gland and is suppressed in the treatment of locally advanced disease?
Testosterone
LHRH injections, androgen antagonists
Which hormone treatments slow the progression of prostate cancer?
LHRH injections
Anti-androgens
Which type of epithelium lines the bladder?
Transitional epithelium, or urothelium
What are the risk factors for transitional cell carcinoma?
Age > 40
PMX of renal disease
Smoking - the main one
Exposure to chemicals - dyes, rubber
Analgesic drugs
Chronic UTI - schistosomiasis
TCC is more common in (men / women).
men
What is the main presenting complaint of bladder cancer?
Haematuria
How is bladder cancer investigated?
Cystoscopy - to view tumours
CT urogram - to view filling defects
What investigation is used to diagnose a bladder cancer?
TURBT
transurethral resection of bladder tumour + biopsy
How is bladder cancer staged?
TNM staging based off biopsy
Patients with bladder cancer must be monitored for how long?
Lifelong monitoring
Bladder tumours are classified based on whether or not they’ve invaded the ___.
muscle
Which immunotherapy drug is used to treat high-risk, non-invasive bladder cancers?
BCG
same used in vaccine for TB
How is
a) low risk
b) high risk
non-invasive bladder cancer managed?
a) Monitored
b) BCG vaccine?!??!?!
How is bladder cancer treated if it has invaded the muscle?
Cystectomy
