Lower urinary and male genital

Question 1

What are common genetic abnormalities in urothelial carcinoma?

Answer 1

• early: p16 (chromosome 9p) deletion
• deletions: 17p, 13q, 11p, 14q
• invasive carcinoma: 17p deletions including p53 deletion
• non-papillary tumors may have early p53 and late p16 mutations

Question 2

What are indications for radical cystectomy in bladder cancer?

Answer 2

• muscularis propria invasion
• CIS refractory to BCG
• cancer invading prostatic urethra or prostatic ducts where BCG can’t get

Question 3

What is the basic pathogenesis of BPH?

Answer 3

• testosterone is converted to the more active DHT by 5alpha-reductase in the stromal cells
• DHT acts on both stromal and epithelial cells to upregulate other growth factors such as FGF7
• excess proliferation of stromal cells and reduced death of epithelial cells

Question 4

What are genes that are silenced by epigenic modification in prostate cancer?

Answer 4

• GSTP1 (most common; normally prevents carcinogenic damage)
• PTEN, RB, p16, MLH1, MSH2, APC

Question 5

What is AMACR?

Answer 5

• an enzyme involved in beta oxidation of branched chain amino acids
• upregulated in prostate cancer

Question 6

What is PSA and what are age-specific ranges?

Answer 6

• a serine protease produced by prostatic epithelium that liquefies semen
• 40-49 years: <2.5 ng/mL
• 50-59 years: <3.5 ng/mL
• 60-69 years: <4.5 ng/mL
• 70-79 years: <6.5 ng/mL

Question 7

What is the association between free PSA value and cancer risk?

Answer 7

Free PSA is inversely proportional to the cancer risk

Higher than 25% indicates low risk of cancer; lower than 10% is a risk of cancer