GU Flashcards
Lymphatics
- prostate
- bladder
- testis
- penis
- periprostatic-obturator-ext iliac
- ext + int iliac nodes-pre sacral iliac nodes
- internal inguinal ring-retroperitoneal LN
- inguinal
Metastasis
- prostate
- bladder
- testis
- penis
- bones liver lungs
- lung bone liver
3. - uncommon
Prognostic indicators
- prostate
- bladder
- testis
- penis
- stage & histological differentiation
- stage (depth of tumour)
grade - non-seminoma–>mediastinal primary=poorer prognosis
- none
Pathology
- prostate
- bladder
- testis
- penis
1, adenocarcinoma
- transitional
- Germ cell
a) seminoma MC
b) non-seminoma - SCC
S&S
- prostate
- bladder
- testis
- penis
- urinary frequency
- gross painless hematuria
- painless mass in scrotum
- ulcerative lesion
Epi/Eti
- prostate
- bladder
- testis
- penis
- MC malignancy in males
Age, race, genetics - Male dominance
smoking and occupational exposure - personal history, family history and cryptochidism
- rare
not being circumsized
Disease management Prostate
T1-2, G2-6, PSA <10, life expectancy <10yrs = observation
T1-2, +ve LN, life expectancy >10yrs= radical proctectomy
ADT deprives tumour of testosterone (for intermediate or high risk)
Chemo- for metastatic disease after ADT fails
RT combined with other modalities
What structures are included in RT volume for intact low and intermediate prostate ca?
Prostate +/- seminal vesicles
What structures are included in the RT volume for intact high risk prostate ca?
Prostate +/- seminal vesicles +/- pelvic nodes
Disease management Bladder
Ta-T1
-Transurethral Resection of Bladder Tumour TURBT
Low grade and small
-partial cystectomy
T2-T4a
-Radical cystectomy
chemo–>if unresectable the chemo is primary therapy
Disease management testis
Sx; primary- radical inguinal orchiectomy
(testis are NOT removed through the scrotum b/c increased risk of seeding
Prostate Dose
EBRT only
-T1-2, PSA <10, Gleason <7
Conventional: 72-76 (200/fx)
Hypo: 60-72.8 (260-300/fx)
Prostate + regional LN
-T3-4, PSA >10, G>7
Conventional: 78/39 to prostate & 46/23 or 50/25 to LN
Hypo; 70/28 to prostate & 50.4/28 to LN
EBRT- prostate bed
-60/30, 66/33 to bed and 46/23 to LN
Prostate only SBRT
3256/5
Bladder Dose
Pre-op
-Tumour >4cm, T3 or T4 45Gy/25
Post op
-45-50Gy
Primary RT:
-64-70 (180-200/fx)
only 45Gy given to whole pelvis LN
Testis dose
Seminoma
Stage I &IIA
23MV APPA 20/10
Stage IIB
2500/160-180 of 20/10
additional boost to tumour and margin of 500-1000/ 160-180
Non-seminoma
RT has little roll
Field Border Prostate
Sup: L5/S1
Inf: Past bottom of obturator foramen
Ant: pubic symphysis
Post: past ischium /mid rectum
Bladder field borders
Phase 1: tx field includes- total empty bladder and tumour and pelvic LN
Phase 2: tumour site/bed +2cm margin
bladder may be full or empty for boost
Testis field border
Seminoma (hockey stick)
Sup: T10
Inf: bottom of L5
lat: include any PA LN and renal hilum-10cm wide and contralateral testicular shielding
Penis RT
POP or 1 ANT field
Circumsized
bolus
Localized very low or low risk prostate ca
no nodal or distant mets
T2a or below
(T1c or below=very low risk)
Grade 1 and PSA <10
If life expectancy <10
- AS
- EBRT or brachy
- radical proctectomy
intermediate risk prostate ca T2b-T2c grade 2 or 3 PSA 10-20 No nodal or distant met
Life expectancy <10
-WW -AS -EBRT +/-ADT (4-6mo) -Brachy alone
Life expectancy >10
-EBRT +/-ADT (4-6mo)+/-brachy
-Brachy alone
or RP
High risk of very high risk no nodal or distant mets
T3a
EBRT +ADT (1.5-3yrs)
EBRT + brachy +/-ADT
RP
Treatment with nodal mets
EBRT + ADT (1.5-3yrs)
or
ADT alone
Treatment where there is distant mets
ADT +/- chemo
