Lecture 11: Prostate and Kidney Cancer Flashcards
What are the risk factors for prostate cancer?
1) age/sex- increases with age especially for over 50
2) diet-high fat diet association
3) family history-3-5x if relative has it
4) race-BLACKS! get it more and have higher rate of aggressive disease
IF age 55-69–>+family history and black—>DRE/PSA—>If DRE + and PSA + (age specific, >4, % freeTransrectal ultrasound/biopsy
If DRE-/PSA- then do annual DRE/PSA until either one is positive
How do you diagnose ze prostate cancer?
1) Digital rectal exam-nodules, firmness
2) Serum Prostate-Specific Antigen (PSA)
- serine protease
- liquefies ejaculate
- prostate specific but NOT cancer specific
- varies with age and benign conditions
- LOW PSA=HIGH CANCER CHANCE (free PSA=amount NOT bound to albumin)
- only validated in PSA 4-10
How do you stage the prostate cancer?
1) cT1-NOT clinically apparent by palpation or imaging
2) cT2-papable confined to prostate
3) cT3-extended outside prostate and/or into seminal vesicles
4) cT4-fixed or involving adjacent organs (rectum, bladder)
How do you treat local prostate cancer?
If localized cancer:
1) active surveillance
2) radical prostatectomy-remove all or part of prostate
3) external beam radiation
4) brachytherapy-radioactive seeds radiate the tumor
What are signs and symptoms of early prostate cancer?
none
What are signs and symptoms of progressive prostate cancer?
1) hesitancy, decreased stream, nocturia
2) hematospermia-blood in semen
3) impotence
What are signs of advanced prostate cancer?
bone pain
What do all of the following have in common?
1) cytoscopy (endoscopy of the bladder)/catherization
2) biopsy
3) benign prostatic hyperplasia
4) prostatitis/urinary infection
5) recent ejaculation
6) bike riding
7) NOT DRE (digital rectal exam)
Factors that can give you FALSELY POSITIVE PSA Elevations
What do you use to stage prostate cancer?
1) pelvic CT or MRI (lymph nodes)
2) bone scan (bone mets)
3) PSA level
4) palpation of prostate cancer extent
How do you treat metastatic prostate cancer?
1) NO CURE
2) androgen deprivation therapy (castration)
- GnRH agonists and antagonists (medical castration)
- orchiectomy (surgical castration)
3) chemotherapy after becoming castration resistant
4) newer therapy: immunotherapy, novel anti-androgens, adrenal androgen synthesis inhibitors
How do you screen prostate cancer? (controversial)
1) prostate specific antigens
2) digital rectal exams
How do you diagnose prostate cancer?
transultrasound guided prostate biopsy
What’s on the differential for a solid renal mass?
1) RENAL CELL CARCINOMA-until proven otherwise, 90%, enhancing spherical mass
2) Oncocytomas-indistinguishable from RCC on imaging
3) Angiomyolipomas-fat density by CT, tuberous sclerosis
4) Urothelial carcinoma-renal pelvis
What are some risk factors for Renal Cancer?
1) smoking dem cigarettes
2) obesity
3) hypertension
4) Von-Hippel Lindau
5) Tuberous Sclerosis
6) Acquired renal cystic disease in patients with end-stage renal disease
What risk factor for renal cancer am I describing?
1) Cerebellar hemangio-blastoma
2) Retinal angiomas
3) Renal cysts
4) Clear renal cell cancer
5) Epididymal cystadenoma
6) Pancreatic cysts
7) Pheochromocytoma
Von-Hippel Lindau
What are the less common differentials for solid renal mass?
1) adrenal tumors
2) renal abscesses
3) xanthogranulomatous pyelonephritis
4) metastases to the kidney (breast, lung primary)
5) lymphoma
What is malignant renal cancer pathology?
1) Clear cell (conventional)
- 85% renal cell carcinoma
- proximal tubules
2) papillary-multifocal and bilateral
3) chromophobe
What is benign renal cancer pathology?
1) Oncocytoma-cannot differentiate from malignant tumor on imaging
2) angiomyolipoma-fat seen on CT is diagnostic
What is the ‘classic triad’ of symptoms seen in renal masses?
1) flank pain
2) palpable mass
3) hematuria
- only 10% have the triad at presentation, usually advanced stage
- 25% of Renal Cell Cancer present with mets
What disease am I describing AND what u gonna do about it?
1) reversible syndrome of hepatic dysfunction (high LFTs)
2) NO mets
Hepatopathy-Stauffer’s Syndrome (signs and symptoms renal cell carcinoma)-paraneoplastic syndrome
Work-Up
1) Cross-Sectional Imaging-CT SCAN preferred or ultrasound
2) If Mets-chest x-ray, bone scan if high alk phos, LFTs, serum Ca, CBC, head CT/MRI if wide mets
3) Renal Biopsy- unnecessary if big, helpful if small tumors
How do you stage kidney tumors?
T1-confined to kidney, 7cm
T3- into major veins or perinephritic tissue
T4-beyond gerona’s fascia
How do you treat kidney tumors?
1) Partial Nephrectomy-PREFERRED
- efficacious and safe
- preserves kidney function
- lowers long term morbidity/mortality
2) Radical Nephrectomy
- previous standard of care
- now ONLY for masses not treatable with partial nephrectomy
3) laprascopic cryotherapy-freeze the tumor
4) percutaneous cryotherapy
5) percutaneous radio frequency ablation (burn it off)/microwave
How do you treat renal cancer with mets?
1) CYTOREDUCTIVE NEPHRECTOMY (kidney removal) FOLLOWED BY IMMUNOTHERAPY IMPROVES SURVIVAL for good surgical candidates
2) poor prognosis
3) resistant to chemo/radiation
4) old treatment immunotherapy with interferon and interleukin
