Cancer of the Urinary System 2 Flashcards
Which micronutrient helps to decrease risk of developing UTI?
Zinc
How are most prostate cancer cases diagnosed?
Through opportunistic testing:
- PSA test
- digital rectal exam
- TRUS-guided prostate biopsy
What is PSA and what does it test for?
Prostate specific antigen
Is specific to the prostate but not necessarily cancer
Describe the symptoms related to local prostatic cancer
Weak stream, Hesitancy Increased frequency Urgency Sensation of incomplete emptying Urge incontinence UTI.
Describe the symptoms related to locally-invasive prostatic cancer
Haematuria, Perineal and suprapubic pain, Impotence, Incontinence, Loin pain or anuria resulting from obstruction of the ureters, Symptoms of renal failure, Haemospermia, Rectal symptoms including tenesmus
What is the commonest site of prostate metastases?
Bone
What is the normal serum range for PSA?
0-4.0 ug/ml
Describe the age-related ranges for PSA
- < 50 years: 2.5 is upper limit
- 50-60 years: 3.5 is upper limit
- 60-70 years: 4.5 is upper limit
- > 70 years: 6.5 is upper limit
Give seven possible causes of an elevated PSA test
- UTI
- chronic prostatitis
- instrumentation (e.g. catheterisation)
- physiological (e.g. ejaculation)
- recent urological procedure e.g. TURP
- BPH (benign prostatic hyperplasia)
- prostate cancer
What is the half life of PSA?
2.2 days
After what time period can a repeat PSA be taken?
3 weeks (8 half lives)
What method is used to grade prostatic cancer?
Gleason Grading system
What are the stages of prostatic cancer?
- Localised stage
- Locally advanced stage
- Metastatic stage
- Hormone refractory stage
Describe the final stage of prostate cancer
• Hormone refractory stage – in prostatic cancer, metastatic disease is NOT the final state. Metastases of prostate cancer can be treated by hormone treatment, but eventually will stop responding – this is hormone refractory stage and is the final stage of prostate cancer.
Describe the treatment options for locally advanced prostate cancer
- Watchful waiting
- Hormone therapy followed by surgery
- Hormone therapy followed by radiation
- Hormone therapy alone (or combination!)
- Intermitted hormone therapy (clinical research)
Describe the potential complications of prostate cancer
- Bone: pain, pathological fractures, anaemia, spinal cord compression
- Rectal: constipation, bowel obstruction
- Ureteric: obstruction resulting in renal failure
- Pelvic lymphatic obstruction: lymphoedema, DVT
- Lower urinary tract dysfunction: haematuria, acute retention
How long does it usually take for prostate cancer to reach the hormone-refractory stage?
18-24 months after commencing treatment
How does testicular cancer usually present?
Painless testicular lump
- may become painful after trauma
Give three tumour markers that can signify testicular cancer
– AFP (alpha-fetoprotein) - teratoma
– beta-HCG (Human Chorionic Gonadotrophin) - mature-type seminoma
– LDH (Lactate dehydrogenase) - non-specific marker of tumour burden
What is the differential diagnosis for a lump in the testis?
Testicular cancer
Infection
Epididymal cyst
Missed testicular torsion
(Cancer until proven otherwise)
How is a testicular lump investigated?
MSSU
Testicular ultrasound scan and CXR
Tumour markers
How is testicular cancer treated?
Radical orchidectomy (inguinal, not through scrotum)
Why should an orchidectomy be done inguinally and not through the scrotum? (When treating testicular cancer)
to avoid disturbing lymphatics and risking metastasis
Which lymph nodes are most likely to be invaded by testicular cancer cells?
Para-aortic lymph nodes
