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Urinary system > Carcinoma of the prostate and PKD > Flashcards

Carcinoma of the prostate and PKD Flashcards

1
Q

Outline the epidemiology of carcinoma of the prostate

A
  • 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
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2
Q

What are the risk factors for prostate cancer?

A
  • Increased age
  • Family history
  • BRACA2 gene mutation
  • Ethnicity - black > white > Asian
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3
Q

Where are lesions most commonly found in the prostate?

A
  • Peripheral zone
  • BPH tends to be more central
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4
Q

How do patients with prostate cancer present?

A
  • Symptoms of UTI
  • Prostatism or metastatic disease in bone causing pain
  • Hesitancy
  • Nocturia
  • Weight loss
  • Opportunistic finding from DRE
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5
Q

What are the differential diagnoses for carcinoma of the prostate?

A
  • BPH
  • Prostatitis
  • Urethral stricture
  • Multiple myeloma
  • Any neurological condition e.g. CVA, Parkinson’s disease, spinal cord compression
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6
Q

What questions would you ask when taking history from a patient with potential prostate cancer?

A
  • Family history
  • Hormone use
  • Haematuria
  • Bone pain
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7
Q

What would you feel on examination of a cancerous prostate?

A
  • Enlarged prostate gland
  • Hard and irregular
  • Obliteration of median sulcus
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8
Q

What would you feel on examination of a prostate affected by BPH?

A
  • Large
  • Firm
  • Can feel 2 lobes
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9
Q

What are some causes of raised PSA?

A
  • Prostate cancer
  • Infection
  • Inflammation
  • Large prostate
  • Urinary retention
  • Digital rectal exam
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10
Q

What does a raised PSA mean?

A
  • 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
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11
Q

How are prostate cancers classified?

A
  • Gleason classification
  • TNM used to stage
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12
Q

How is prostate cancer diagnosed?

A
  • 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
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13
Q

What can happen to patients with advanced prostate cancer?

A
  • Sclerotic bone lesions
  • Stand out as ‘hot spots’ on bone scans
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14
Q

How is localised prostate cancer treated?

A
  • 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
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15
Q

How is advanced prostate cancer treated?

A
  • Advanced tumours: hormonal manipulation is beneficial since testosterone promotes tumour growth
  • Testosterone and dihydrotestosterone
  • Surgical castration/medical castration (LHRH agonists/GnRH agonists)
  • Palliative care
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16
Q

Outline the epidemiology of polycystic kidney disease

A
  • Accounts for 8-10% of CKD
  • Most common inherited nephropathy
  • Autosomal dominant and autosomal recessive
17
Q

How does PKD present?

A
  • 30-40 years of age
  • Complications of hypertension
  • Acute loin pain
  • Haematuria
  • Bilateral palpable kidneys
18
Q

Outline the pathophysiology of PKD?

A
  • Cysts develop anywhere in the kidney
  • They compress surrounding parenchyma and impair renal function
19
Q

Describe the cysts that are seen in PKD

A
  • 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
20
Q

What can happen to cysts in patients with CKD?

A
  • 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
21
Q

What can APKD result in?

A
  • 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
22
Q

What are the causes of morbidity and mortality in patients with PKD?

A
  • Hypertension
  • MI and cerebrovascular disease
  • Also leads to progressive CKD
23
Q

What does treatment of PKD involve?

A
  • Control BP
  • Dialysis and renal transplant needed if end-stage renal failure develops
24
Q

What investigations need to be done to look into PKD?

A
  • Bloods
  • Urine dipstick
  • CXR
  • ECG
  • Physical exam
  • Fundoscopy
25
Q

What immediate management steps should you take once a patient is diagnosed with PKD and their cysts have ruptured?

A
  • 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
26
Q

Can PKD be screened for?

A
  • 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

Urinary system (22 decks)

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