Howell App Flashcards by Sara Fieger

risk factors of prostate cancer

Age
Race
Family History
High fat diet

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shared decision making

working with patient to determine outcome

PSA, DRE

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PSA

glycoprotein produced only by prostate

prostate specific antigen

tumor marker - increases in levels due to increase in size of prostate

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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

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PSA Velocity

used as a screening risk

check PSA range over time

Rise of >0.35 ng/mL indicates “rapid” increase

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reasons why PSA could be elevated (5)

malignancy
UTI
prostatitis
prostatic trauma
BPH

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abnormal findings on DRE

induration or nodularity

prostate should be considered suspicious for prostate cancer

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limitations of DRE

Finger length

body habitus of patient

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Prostate Cancer metastasis

bone meds to lower back

evaluate with bone scan + Xray

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Histologic type of prostate cancer

Adenocarcinoma

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Diagnostic analysis of prostate cancer

Prostate biopsy via TRUS
MRI
Conventional radionucletide bone scan

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Prostate Biopsy via Transrectal Ultrasound

Tumors are hypoechoic on TRUS

TRUS IS NOT first line alone

Expensive, invasive, LOW specificity

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Standard method of detecting/proving prostate CA

Prostate biopsy via TRUS

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MRI prostate cancer benefits

Evaluation of prostate as well as regional lymph nodes

Better at staging than TRUS

Non-invasive, non-radiation

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scale used in staging of prostate cancers

Gleason scale

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stage 1

No symptoms, confined to prostate

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stage 2

Hard nodule on rectal exam, confined within prostate

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stage 3

Spread out of prostate capsule, urinary symptoms appear

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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