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Urology > Lecture 25 Tumours of the Urinary System Prostate and Testicular Cancers > Flashcards

Lecture 25 Tumours of the Urinary System Prostate and Testicular Cancers Flashcards

1
Q

What is the most commonest cancer diagnosed in young men

A

Prostate

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2
Q

The majority of prostate diagnosis are in what age group

A

> 65 years

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3
Q

Name risk factors for prostate cancer

A 
Age
Ethnicity
Geography
Family history- first degree relative 2x likely 
Food- omega 3 fatty acids, vitamin E
Finasteride
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4
Q

What genes are linked to prostate cancer

A

HPC1; BRCA1 & 2

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5
Q

How to most prostate cancers present

A

Asymptomatic

Localised

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6
Q

How is prostate cancer initially diagnosed

A

PSA
Digital rectal exam
TRUS- guided prostate biopsies

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7
Q

What are localised prostate cancer presenting symptoms

A
  • Weak stream
  • Hesitancy
  • Sensation of incomplete emptying
  • Frequency
  • Urgency
  • Urge incontinence
  • Urinary tract infection
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8
Q

What are locally invasive disease presenting symptoms

A
  • Haematuria
  • Perineal and suprapubic pain
  • Impotence
  • Incontinence
  • Loin pain or anuria
  • Symptoms of renal failure
  • Haemospermia
  • Rectal symptoms including tenesmus
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9
Q

Distant metastatic presenting symptoms

A 
Bone pain
Sciatic pain
Paraplegia- cord compression 
LN enlargement 
Lymphoedema
Loin pain
Anuria
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10
Q

Widespread metastatic symptoms

A

Weight loss

Lethargy (anaemia, uraemia)

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11
Q

What is the commonest mode of presentation for prostate cancer?

a) Frank haematuria
b) Asymptomatic (i.e. incidentally noted)
c) Acute urinary retention
d) Symptoms of benign prostatic enlargement and obstruction
e) Bone pain

A

b) Asymptomatic (i.e. incidentally noted)

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12
Q

What is the normal serum level for PSA

A

Normal serum range 0-4.0 g/mL

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13
Q

What can cause elevated PSA

A
  • UTI
  • Chronic prostatitis
  • Catheterisation
  • Ejaculation
  • Recent urological procedure
  • BPH
  • Prostate cancer
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14
Q

What is the half life of PSA

A

2.2 days

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15
Q

If you are repeating a PSA blood test, when should you recheck

A

At lease 3 weeks (half life 8)

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16
Q

Gleason sum score 3+3=6 ISUP grade group

A

1

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17
Q

Gleason sum score 3+4 =7 ISUP grade group

A

2

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18
Q

Gleason sum score 4+3= 7 ISUP grade group

A

3

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19
Q

Gleason sum score 8 ISUP grade group

A

4

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20
Q

Gleason sum scare 9 and 10 ISUP grade group

A

5

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21
Q

What are the stages of prostate cancer

A
  • Localised
  • Locally advanced
  • Metastatic
  • Hormone refractory
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22
Q

How is prostate cancer staged

A
  • Digital rectal examination (local staging)
  • PSA
  • Transrectal US guided biopsies
  • CT (regional and distant staging)
  • MRI (local staging)
23
Q

How is localised prostate cancer treated

A 
•	Watchful waiting
•	Radiotherapy
–	External-beam
–	Brachytherapy
•	Radical prostatectomy
–	Open
–	Laparoscopic
–	Robotic
•	Others under investigation
–	Cryotherapy
–	Thermotherapy
24
Q

How is locally advanced prostate cancer treated

A
  • Watchful waiting
  • Hormone therapy followed by surgery
  • Hormone therapy followed by radiation
  • Hormone therapy alone
  • Intermitted hormone therapy
25
Q

Name types of hormonal therapy for prostate cancer

A

Surgical castration- LHRH antagonists/analogues
Anti-androgens- inhibits androgen receptors
Oestrogens- inhibits LHRH and testosterone secretion. direct cytotoxic effect on prostatic epithelial cells

26
Q

Treatment of metastatic prostate cancer

A

HT + Chemotherapy; HT + Abiraterone; or HT alone

27
Q

Treatment for refractory prostate cancer

A
  • Max HT + steroids, oestrogens, Chemotherapy,

* Abiraterone

28
Q

The following are reasonable treatment options for low-risk localised prostate cancer except:

a. External beam radiotherapy 
b. Active surveillance
c. Brachytherapy
d. Radical prostatectomy
e. Radical chemotherapy
A

e. Radical chemotherapy

29
Q

The following statements about screening for prostate cancer are true except

a) PSA is the best available screening test
b) Compared with ad-hoc opportunistic PSA testing, screening for prostate cancer is beneficial because it saves lives
c) If screening is advocated, it should be performed for men at risk of prostate cancer rather than the entire male population
d) Screening for prostate cancer is not currently advocated
e) For suspicious cases detected by screening, there is a need to undergo a definitive test to confirm or exclude presence of prostate cancer

A

b) Compared with ad-hoc opportunistic PSA testing, screening for prostate cancer is beneficial because it saves lives

30
Q

What is the presentation of testicular cancer normally

A

Painless lump

31
Q

What is the presentation of testicular cancer less often

A

• tender inflamed swelling
• history of trauma (although trauma NOT a risk factor)
• symptoms/signs from nodal or distant metastasis
o para-aortic lymph nodes
o chest
o bone

32
Q

Describe the incidence of testicular cancer amongst men

A
  • One of the commonest cancers in young men
  • Peak incidence 3rd decade
  • High risk in Caucasians
33
Q

Name risk factors for testicular cancer

A

o Testicular maldescent
o Infertility
o Atrophic testis
o Previous cancer in contralateral testis

34
Q

What is the precursor lesion for testicular cancer

A

testicular germ cell neoplasia in-situ

35
Q

What tumour markers are associated with testicular cancer

A

– AFP (alpha-fetoprotein) (teratoma)
– HCG (Human Chorionic Gonadotrophin) (seminoma)
– LDH (Lactate dehydrogenase) (non-specific marker of tumour burden

36
Q

How is testicular cancer diagnosed

A

Examination for lump
MSSU
Testicular US and CXR
Tumour markers

37
Q

How is testicular cancer treated

A
  • Radical orchidectomy is essential- remove your testicle and the spermatic cord
  • Occasionally may need biopsy of ‘normal’ contralateral testis if high risk for tumour
38
Q

What does further treatment depend on in testicular cancer

A

tumour type, stage (TNM) and grade

39
Q

For testicular cancer, the main lymphatic spread to regional lymph nodes occurs in which group of lymph nodes?

a. Scrotal lymph nodes 
b. Inguinal lymph nodes
c. Pelvic lymph nodes (i.e. internal iliac chain)
d. Mediastinal lymph nodes
e. Para-aortic lymph nodes
A

e. Para-aortic lymph nodes

40
Q
  1. When performing radical inguinal orchidectomy for testicular cancer:

i. Where is the incision made?
ii. Why is the incision made here?

A

Just above the pubic tubercle (pubic bone) near the inguinal ligament.
. This incision facilitates access to both the testicle and the proximal inguinal canal.

41
Q

Name the 2 types of germ cell tumours in testicular cancer

A

Seminomatous GCT

Non-seminomatous GCT

42
Q

Name the 3 types of non-germ cell tumour

A

Leydig
Sertoli
Lymphoma

43
Q

Seminomatous main affects what age group

A

30-40 year olds

44
Q

Non-seminomatous normally affects what age group

A

20-30 year olds

45
Q

What is grading assessing in testicular cancer

A

Aggressiveness

  • Low grade = well differentiated
  • High grade = poorly differentiated
46
Q

What is staging assessing in tetsticular cancer

A

Spread

47
Q

What 3 ways ca testicular cancer spread

A

Local- local invasion to adjacent structures
Regional- lymph nodes
Distant- lungs, bone, liver

48
Q

Stage 1 testicular cancer

A

Disease confined to testic

49
Q

Stage II testicular cancer

A

Infradiaphragmatic nodes involved

50
Q

Stage III testicular cancer

A

Supradiaphragmatic nodes involved

51
Q

Stage IV testicular cancer

A

extralymphatic disease

52
Q

What is the treatment for low stage, marker negative testicular cancer

A
  • Surveillance

* Adjuvant radiotherapy (SGCT only)

53
Q

What is the treatment for nodal disease, persistent tumour markers or relapse surveillance

A
  • Combination chemotherapy

* Lymph node dissection (NSGCT only)

54
Q

What is the treatment for metastatic testicular cancer

A
  • First line chemotherapy

* Second line chemotherapy

Urology (26 decks)

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