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URO > cancer de prostata > Flashcards

cancer de prostata Flashcards

1
Q

prostata

A

glanda
dimens 25-30 cm, gr 20g
in loja prostatica
traversata de uretra prostatica si canalele ejaculatoare

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2
Q

din zona tranzitionala se dezv

A

HBP cu simptome precoce mictionale

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3
Q

din zona periferica se dezv

A

cancerul de prostata cu dg tardiv

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4
Q

def

A

tumora maligna a acinilor prostatici

periferic, multicentric

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5
Q

epidemio

A

cel mai frecv neo la barbati

evolutie lenta, adesea oculta

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6
Q

etio

A

initiere - forma histo, varsta

promotori - forma evidenta clinic

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7
Q

FR

A 
varsta - medie dg 68 ani
rasa - afroamericanii
genetic, ereditar
   sporadic
   familial
   ereditar - 3 pers in ultimele 3 gen sau 2 cu dg <55 ani
sdr metabolic, obezitate
factori de mediu - rad gamma, cadmiu, hc aromatice, vit d
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8
Q

factori de protectie

A

mediu - Se, vit E si D, licopen, usturoi, ceapa, praz, soia, ceai verde
farma - inhib 5 alfa reductaza (finasterid), statine, AINS

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9
Q

clinic

A

incipient - asimptomatic
evol locala lenta (debut microscopic —> extensie extracaps - fereastra de dg >5 ani)
infiltrare neo - col VU (simptome urinare obstruct/irit), sfincter ext, rect, trigon vezical, meat ureteral (-> IR obstruct)
hematurie, hematospermie
durere locala
sdr de impregnare maligna

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10
Q

screening

A

PSA (VN 0-4 ng/ml –> >4 punctie prostatica) & TR
la toti barbatii >50 ani (>40 ani daca au FR) anual
oprit dupa 70 ani

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11
Q

TR - stadializare

A

T1- fara modificari
T2 - nodul dur ce nu depaseste capsula
T3 - tumora depaseste capsula prostatica
T4 - tu vol prostato-pelvina fixa la structurile vecine

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12
Q

suspiciune dupa screening

A

PSA> 4
cresterea PSA cu >0,75/an
TR anormal
–> biopsie prostatica ecoghidata

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13
Q

ecografia transrectala

A

identif lez suspecte

creste acuratetea biopsiei

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14
Q

clasif Gleason

A 
1 - f bine dif
2 - bine dif
3 - mediu dif
4 - slab dif
5 - nedif/anaplazic
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15
Q

scor Gleason

A

bine dif 2-4
moderat dif 5-7
slab dif 8-10

corel cu stadiul clinic, invazia ggl, extensia locala

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16
Q

T1

A

clinic inaparenta, nedecelata prin imagistica
1a - <5% tesut rezecat la TURP
1b - >5% tesut rezecat
1c - PBP dupa PSA cu val crescute

17
Q

T2

A

lim in int prostatei, nu depaseste capsula
2a - <1/2 lob
2b - >1/2 lob, nu ambii lobi
2c - ambii lobi

18
Q

T3

A

depaseste capsula
3a - extensie uni/bilat
3b - invazie vezicule seminale

19
Q

T4

A

fixata/ invazia altor struct
4a - invazie sf ext, col VU, rect
4b - invazie ms ridicatori anali, fixare de perete pelvin

20
Q

cum se face stad T?

A

US transrectala
elastografie
RM multiparametric (cancer - hiposemnal)

21
Q

extensie la distanta

A 
limfofil si osteofil
n1 - meta ggl reg (ggl obturatori, iliaci)
m1 - meta la dist
   m1a - limfoggl non-reg
   m1b - meta osoase
   m1c - alte loc
22
Q

ddx - cresteri ale PSA

A

HBP
prostatita cr
instrumentare/manipulare urologica
infectie urinara

23
Q

ddx - modif ale prostatei la TR

A

litiaza prostatica
TB urogenit
APP de TURP

24
Q

tratament - T1a-T2a

A

supravegherea activa (mai ales pacienti cu speranta de viata <10 ani)
TR & PSA la 3 luni primii 2 ani apoi la 6 luni
PBP la 18 luni

25
Q

tratament - T1b - T2

A

prostatectomie radicala - prostata + vezic seminale + tes grasos periprostatic + anastomoza VU-uretra
radioterapie ext/ brahiterapie interstitiala
HIFU
criochirurgie

26
Q

tratament - T3-T4

A

radioterapie ext + hormonoterapie

27
Q

tratament - N+, M+

A

hormonoterapie (blocada androgenica)
antiandrogeni + orhiectomie bilat
antiandrogeni + analogi LHRH

28
Q

post-operator prostatectomie radicala

A

PSA = 0 -> interventia radicala
PSA > 0,1 -> tu restanta
PSA 0 post op cu crestere ulterioara -> recidiva tu

29
Q

complicatii radioterapie

A

uro - cistita radica, hematurie, strictura uretrala, incontinenta urinara
dig - diare, tenesme, ocl intest/rect
impotenta
hema, imuno

30
Q

brahiterapia interstitiala

A

implant perm transperineal de surse radioactive

I: T1c-T2a, scor Gleason <7, PSA <10, vol prostatic <50ml fara rezectie endoscopica ant

31
Q

antiandrogenii - repr, RA

A

flutamida, bicalutamida

RA - hepatotoxicitate, ginecomastie, hipocalcemie

32
Q

agonistii LHRH

A

init o crestere a testosteronului in primele 2-3 sapt apoi scade ff mult (~castrare chir)
leuprolid acetat, goserelina, buserelina

33
Q

trat in stadiu localizat

A

prostatectomia radicala

radio ext/brahiterapie interstitala/ hifu

34
Q

trat in stadiu avansat loco-regional

A

radioterapie ext + trat H

URO (4 decks)

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