Carcinoma of the prostate and PKD Flashcards
Outline the epidemiology of carcinoma of the prostate
- Commonest cancer in men
- 2nd commonest cause of death from cancer in men
- 1 in 8 men will be diagnosed in their lifetime
- Rare in men <50
What are the risk factors for prostate cancer?
- Increased age
- Family history
- BRACA2 gene mutation
- Ethnicity - black > white > Asian
Where are lesions most commonly found in the prostate?
- Peripheral zone
- BPH tends to be more central
How do patients with prostate cancer present?
- Symptoms of UTI
- Prostatism or metastatic disease in bone causing pain
- Hesitancy
- Nocturia
- Weight loss
- Opportunistic finding from DRE
What are the differential diagnoses for carcinoma of the prostate?
- BPH
- Prostatitis
- Urethral stricture
- Multiple myeloma
- Any neurological condition e.g. CVA, Parkinson’s disease, spinal cord compression
What questions would you ask when taking history from a patient with potential prostate cancer?
- Family history
- Hormone use
- Haematuria
- Bone pain
What would you feel on examination of a cancerous prostate?
- Enlarged prostate gland
- Hard and irregular
- Obliteration of median sulcus
What would you feel on examination of a prostate affected by BPH?
- Large
- Firm
- Can feel 2 lobes
What are some causes of raised PSA?
- Prostate cancer
- Infection
- Inflammation
- Large prostate
- Urinary retention
- Digital rectal exam
What does a raised PSA mean?
- Not specific enough to detect prostate cancer
- Possible to have prostate cancer even if PSA readings are low
- The higher PSA is, the more likely the chance of prostate cancer
How are prostate cancers classified?
- Gleason classification
- TNM used to stage
How is prostate cancer diagnosed?
- DRE - hard and irregular prostate
- Ultrasound used to define prostatic mass
- Increased PSA levels in blood
- Biopsy of prostate provides histological diagnosis
- Radiographs and bone scans used to stage tumours
What can happen to patients with advanced prostate cancer?
- Sclerotic bone lesions
- Stand out as ‘hot spots’ on bone scans
How is localised prostate cancer treated?
- Surgery, hormone therapy, or radiotherapy
- Depends on stage of tumour
- T1/T2 - radical surgical resection of prostate may be curative, transurethral resection may be required
- Local radiotherapy if patient is unfit for surgery and to treat local or distant spread of tumour
- Surveillance
How is advanced prostate cancer treated?
- Advanced tumours: hormonal manipulation is beneficial since testosterone promotes tumour growth
- Testosterone and dihydrotestosterone
- Surgical castration/medical castration (LHRH agonists/GnRH agonists)
- Palliative care
Outline the epidemiology of polycystic kidney disease
- Accounts for 8-10% of CKD
- Most common inherited nephropathy
- Autosomal dominant and autosomal recessive
How does PKD present?
- 30-40 years of age
- Complications of hypertension
- Acute loin pain
- Haematuria
- Bilateral palpable kidneys
Outline the pathophysiology of PKD?
- Cysts develop anywhere in the kidney
- They compress surrounding parenchyma and impair renal function
Describe the cysts that are seen in PKD
- Yellow fluid-filled cysts replace parenchyma
- Haemorrhage into cysts can occur
- Microscopically, cysts are lined by cuboidal epithelium
- Ultrasound/CT shows bilateral enlarged kidneys with multiple cysts
What can happen to cysts in patients with CKD?
- Cysts begin to form in childhood but don’t become clinically evident until adulthood
- Can fill with blood following trauma
- Results in severe abdominal pain and macroscopic haematuria
- Can also become infected - which is difficult to clear
What can APKD result in?
- Hypertension and CKD
- May have cysts in other organs including liver, pancreas, ovaries, lungs and thyroid
- Can also be associated with valvular heart disease, diverticular disease, berry aneurysm
What are the causes of morbidity and mortality in patients with PKD?
- Hypertension
- MI and cerebrovascular disease
- Also leads to progressive CKD
What does treatment of PKD involve?
- Control BP
- Dialysis and renal transplant needed if end-stage renal failure develops
What investigations need to be done to look into PKD?
- Bloods
- Urine dipstick
- CXR
- ECG
- Physical exam
- Fundoscopy
What immediate management steps should you take once a patient is diagnosed with PKD and their cysts have ruptured?
- If cysts have ruptured, main issue is pain control (presence of clots in renal collecting system causes renal colic)
- IV fluids should be given to increase urine output and flush clot out
- Should be given advice on how to manage episodes of macroscopic haematuria
- Advise to avoid contact sports in which abdominal trauma may occur
Can PKD be screened for?
- Genetic screening not useful unless a large number of family members with disease are available for linkage
- Screen on annual basis for elevated BP or urine dipstick abnormalities
- Once in late teens, ultrasound can be performed to look for cysts
- Absence of cysts at this stage makes PKD unlikely
