Oncology Flashcards
Diagnostic investigation for prostate cancer
multiparametric MRI scan - can show Ca and staging
Which part of the prostate is effected in BPH
transitional zone, hence why it usually presents with lower urinary tract symptoms
Which part of the prostate is effected in prostate cancer
peripheral zone
zones of the prostate
central, peripheral, transitional
epidemiology of prostate ca
8% of all men. peak >70
western disease. afrocaribean 3x more likely
Presentation of prostate ca
opportunistic screening
haematuria/haematospermia
?LUTS
Advanced - bony pain, neurology/cauda equina, systemic symptoms
LUTS
storing - urgency, urgent incontinence, nocturia
voiding - dribbling, hesitancy, slow stream, incomplete emptying
Red flag symptoms for prostate cancer
UTIs, bed wetting, haematuria, neurology. FH pf prostate ca and breast ca (related to BRCA1)
PSA density
PSA/prostate volume.
over 1.5 then more likely to be prostate ca
free PSA levels and Ca risk
higher risk of ca if free:total PSA ratio is low (ie there is higher levels of free psa)
normal PSA level
40-50 = 2.5 50-60 = 3.5 60-70 = 4.5 70-80 = 6.5 in general if over 3 not normal
psa level and mets
less than 1% with a PSA under 20 have bony mets and less than 5% have nodal mets
2WW to urology referal criteria for prostate ca
prostate feels malignant
PSA levels are above age-specific range
consider PSA in men with LUTS, erectile dysfunction or visible haematuria
staging of prostate ca
T1 - inside prostate, cant be felt by dr during exam
T2 - inside. can be felt but not spread outside
T3 - Cancer spread outside into nearby tissues
T4 - cancner spread into nearby organs
Grading of prostate Ca
transperineal vs transrectal Gleason grading 1-5 (1= small, unifrom glands. 2=more space (stroma) between glands. 3=distinctly infiltration of cells from glands are margins. 4=irregular masses of neoplastic cells with few glands. 5=lack of occasional glands, sheets of cells). takes 2 most common grades of cell and adds them together to make the gleason score. 1=3+3 (insignificant, just keep an eye) 2=3+4 3=4+3 4=8 5=9-10
treatment options for prostate ca
watchful waiting - usually in elderly or infirm. symptomatic treatment if they become symptomatic
active surveillance - presever QoL. watch and give treatment if get worse
Radical prostatectomy/radiotherapy - definitive treatment
side effects of radiacal prostatectomy/radiotherapy
loss of sexual function (in up to 90%) and incontinence (5% at 1 year)
which cancers usually metastasise to the bone
prostate kidneys lungs thyroid breasts (come in twos or 2 lobes)
what is special about prostate bony mets
prostate sclerotic.
lung, kidney, thyroid, breast are lytic
management of diagnosis of advanced prostate cancer (cauda equina)
catheter
degarelix (hormonal therapy - LHRH antagonist - immediate reduction in testosterone
dexmethosome 16mg initially then 4mg QDS
risk factor for bladder ca
occupation (pain and rubber), older men, smoking
main type of bladder ca
transitional
squamous - western world if have long term catheter, recurrent UTI,, stones. egypt - schistomtiasis
adenocarcinoma- urethral remnant
2WW criteria for bladder ca
man over 40 with visible haematuria
over 60 unexplained non-visible haematuria and dysuria/raised WCC
consider non urgent referral if over 60 and recurrant UTI
investigations for bladder ca
Cystoscopy
CT urogram (in visible haematuria)
TURBT - muscle invasiv or not? grade and staging
