Bladder and Prostate cancer

Question 1

What kind of epithelium lines the prostatic urethra?

Answer 1

Transitional cell

Question 2

What do the ejaculatory ducts unite?

Answer 2

Seminal vesicles and the vas deferens

Question 3

Where do most prostate cancers arise from?

Answer 3

The peripheral zone

Question 4

What kind of cancer arises from the peripheral zone of the prostate?

Answer 4

Adenocarcinoma

Question 5

What kind of bony metastases do you get in prostate cancer?

Answer 5

Sclerotic

Question 6

What is the scoring system used form prostate cancers?

Answer 6

Gleason scoring

Question 7

What is the initial feature described by gleason scoring?

Answer 7

Loss of basement membrane

Question 8

Explain briefly how gleason scoring works?

Answer 8

The architectural scoring is graded from 1 to 5 based how how disorganised it is. he two most abundant patterns are then added together to give a score between 2 and 1.

Question 9

Give for options for the treatment of organ defined prosatate cancer?

Answer 9

Watchful waiting
Active monitoring
Radical surgery
Radial radiotherapy

Question 10

Give three options for the treatment for locally advanced prosate cancer

Answer 10

Radiotherapy + hormonal therapy
Watchful waiting (patients with well differentiated tumours and a life expectancy of less than 10 years.
Hormonal therapy (symptomatic patients who are unfit for radical treatment)

Question 11

What two hormonal therapies are used in metastatic disease?

Answer 11

LNRH analogues

Anti androgens

Question 12

How do LNRH analogues work?

Answer 12

LNRH agonists eventually result in the down regulation of LNRH receptors with subsequent suppression of pituitary LH and FSH secretion and testosterone production.
LNRH analogues initially stimulate pituitary LNRH receptors and cause a transient rise in LH and FSH release and so elevate testosterone production.

Question 13

What is the risk with starting an LNRH analogue?

Answer 13

The transient rise in testosterone production can cause catastrophic spinal cord compression

Question 14

How to you reduce the risk of catastrophic spinal cord compression when starting an LNRH analogue?

Answer 14

Anti androgen cover 1 week before and two weeks after the first LNRH injection.

Question 15

Give an example of an anti androgen steroidal medication

Answer 15

Cyproterone acetate

Question 16

How to anti androgen drugs work?

Answer 16

Compete with testosterone and dihydrotestosterone for binding sites on their receptors in the prostate cell nucelus

Question 17

Give an example of an anti androgen that maintains libido and sexual interest

Answer 17

Non steroidal such as nilutamide and flutamide

Question 18

What are the main side effects of steroidal anti androgen drugs?

Answer 18

Loss of libido and erectile dysfunction

Question 19

What is the main side effect on non steroidal anti androgen drugs?

Answer 19

Gynaecomastia, breast pain

Question 20

What is sterile pyuria?

Answer 20

presence of elevated numbers of white cells in urine which appears sterile using standard culture techniques.

Question 21

A 65 year old man is found to have sterile pyuria and symptoms of cystisis.

Answer 21

Bladder cancer until proven otherwise

Question 22

A 67 year old retired jute mill worked presents with haematuria. What investigation do you order?

Answer 22

IV urogram and cystoscopy

Question 23

What is the most common type of bladder cancer?

Answer 23

Transitional cell

Question 24

What is the most common type of transitional cell carcinoma found in the bladder?

Answer 24

Papillary