Howell App Flashcards
risk factors of prostate cancer
Age
Race
Family History
High fat diet
shared decision making
working with patient to determine outcome
PSA, DRE
PSA
glycoprotein produced only by prostate
prostate specific antigen
tumor marker - increases in levels due to increase in size of prostate
Screening PSA
(sensitive/specific) + when to start
SENSITIVE not specific (bc it doesn’t eliminate other possible causes)
Begin checking PSA at 40, or 10 years prior to first degree relative diagnosis
PSA Velocity
used as a screening risk
check PSA range over time
Rise of >0.35 ng/mL indicates “rapid” increase
reasons why PSA could be elevated (5)
malignancy UTI prostatitis prostatic trauma BPH
abnormal findings on DRE
induration or nodularity
prostate should be considered suspicious for prostate cancer
limitations of DRE
Finger length
body habitus of patient
Prostate Cancer metastasis
bone meds to lower back
evaluate with bone scan + Xray
Histologic type of prostate cancer
Adenocarcinoma
Diagnostic analysis of prostate cancer
- Prostate biopsy via TRUS
- MRI
- Conventional radionucletide bone scan
Prostate Biopsy via Transrectal Ultrasound
Tumors are hypoechoic on TRUS
TRUS IS NOT first line alone
Expensive, invasive, LOW specificity
Standard method of detecting/proving prostate CA
Prostate biopsy via TRUS
MRI prostate cancer benefits
Evaluation of prostate as well as regional lymph nodes
Better at staging than TRUS
Non-invasive, non-radiation
scale used in staging of prostate cancers
Gleason scale
stage 1
No symptoms, confined to prostate
stage 2
Hard nodule on rectal exam, confined within prostate
stage 3
Spread out of prostate capsule, urinary symptoms appear
stage 4
Spread beyond prostate to lymph nodes and bones (urine, bone pain, weight loss, fatigue)
tx options of prostate cancer
active surveillance
radical prostatectomy
radiation therapy
androgen manipulation
active surveillance
avoid tx in men who will not have disease progression
accurately discuss risks/benefits
(low Gleason score, age and health)
radical prostatectomy removes what
Removal of entire system (prostate, vas deferens, seminal vesicle)
Tx with most proven ability for long term cure for prostate cancer
prostatectomy
PSA and prostatectomy
PSA should drop following surgery
if PSA rises later( >0.2 ng/mL) indicates metastasis or recurrence
PSA is sensitive AND specific here
Radical prostatectomy
3 treatment approaches:
Transperineal
Open retropubic
Laporoscopic
Radical prostatectomy in patients with what stage?
Used in patients with LOW stage
adjunctive stages 3,4
Primary alternative for localized prostate cancer
external beam radiation
risk for damage to bladder or rectum
Transperineal implantation of radioisotopes
+ PSA
Seeds
Monotherapy or combined
PSA can rise for up to 20 months after initiation bc radiation cases inflammation and necrosis
Androgen Manipulation and prostate CA
what does it do?
Most are hormone dependent
Decrease prostate size, improvement in disease symptoms, decline in serum PSA
“rapid regression”
Androgen Manipulation
Long Term Side effects: (7)
Hot flashes
loss of libido
impotence
osteoporosis
decreased facial hair
loss of muscle mass
weight gain
BPH V prostate cancer
Prostate CA is most commonly asx and found “incidentally”
PC: Elevated Alkaline and Phosphate
risk factors of bladder CA
Cigarette smoking
Exposure to industrial solvents
Dyes
MC in men
MC presentation of bladder CA
gross or microscopic hematuria (typically painless)
tools used to diagnose and stage bladder CA
Cystoscopy
Transurethral resection
grading of bladder CA
size
pleomorphism
mitotic rate
hyperchromatism
categories (depth) of bladder CA
Superficial
Invasive
Metastatic
types of bladder CA
Urothelial (90%)
Squamous
Adenocarcinoma
bulky tumor, hope to reduce size before cystectomy:
neo-adjuvant systemic therapy
benefit of immunotherapeutic agents delivered DIRECTLY to bladder
Reduces likelihood of recurrence in those who have undergone complete transurethral resection of dysplastic/CA cells
most effective form of intravesical chemo
BCG
reduces likelihood of recurrence in those who have undergone complete resection of dysplastic CA cells
BCG
basically giving a patient TB
still have similar symptoms to other tx mechanisms BUT
also TB symptoms
types of bladder diversion
Ileal conduit (older, sicker)
Continent catheterizable reservoir
Orthotopic neobladder (younger patients)
extent of bladder CA
LE edema and pelvic pressure
CA extends beyond bladder
symptoms can be explained by compression of local structures
staging of bladder CA based on (2)
extent (depth) into bladder wall
presence of regional or distance mets
T3 bladder CA tx
radical cystectomy and irradiation or combo of chemo and sx/radiation
HIGH risk of progression compared to lower stage
