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Basics of Focal Therapy Slidedeck > Prostate Anatomy and Physiology > Flashcards

Prostate Anatomy and Physiology Flashcards

1
Q

Walnut sized gland that produces seminal liquid

A

Prostate

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2
Q

Critical structure that controls continence

A

Sphincter

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3
Q

Critical Structure that control sexual function

A

Neurovascular bundle

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4
Q

Group of abnormal cells that grow more rapidly than normal cells and refuse to die

A

Cancer

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5
Q

Gland located behind the pubic zone and in front of the rectum

A

prostate

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6
Q

Gland surrounding the bottom bladder neck

A

prostate

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7
Q

Roughly how many new prostate cancer cases are dx each year

A

between 260,000 bd 270,000

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8
Q

How many deaths are caused by prostate cancer each year

A

34,5000

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9
Q

How many prostate biopsies are performed each year

A

1 million

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10
Q

How many american men are living with prostate cancer

A

3.1 million

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11
Q

Localized prostate cancer, not papable on DRE

A

T1

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12
Q

Localized prostate cancer palpable during DRE

A

T2

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13
Q

Locally advnaced prostate cancer with extracapsular extraction

A

T3

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14
Q

Locally advnaced prostate cancer, met to local structures

A

T4

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15
Q

Specific biological marker for the prostate

A

Prostate specific antigen test

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16
Q

what is the threshold PSA to raise concern

A

Greater than 4

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17
Q

Four reason, other than cancer, why a PSA level would be high

A
  1. UTI
  2. Prostate stimulation
  3. Vigourus exercise
  4. Medications
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18
Q

BX method performed by the majority of urologists in the United States

A

Transrectal

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19
Q

Value of a transperineal BX

A

limit hospital aquired infections

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20
Q

How many cores are sampled during a randomized BX

A

12

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21
Q

Grade Group with Gleason 6

A

1

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22
Q

Grade Group 3, Gleason score

A

7 4+3

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23
Q

Grade Group Gleason 4

A

8

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24
Q

What is Gleason score and GG is considered low/very low

A

6/1

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25
Q

What is Gleason score and GG is considered Intermediate Favorable

A

7 (3+4)/2

26
Q

What is Gleason score and GG is considered Intermediate favorable

A

7 (4+3) / 3

27
Q

What Gleason score and GG is considered intermediate/unfavorable

A

7 (4+3) / GG 3

28
Q

What Gleason score and GG is considered high risk

A

8/4

29
Q

Evaluated by a pathologist and is assigned score based on cell arraingmenbt

A

Each BX core

30
Q

Scale used to predict probability of cancer that is clinicall significant and is imaged using a combination of T2W, DWI, DCE imaging findings

A

PI-RADS Score

31
Q

Helps detect extraprostatic extension and finds suspicious areas

A

PI-RADS v2.1 scoring

32
Q

Limitations of random core BX

A

Cancer can be missed/under-estimated

33
Q

Uses MRI to sample 2-3 additional core per target beyond the standard 12

A

Targeted BX

34
Q

DX tool using software based fusion with MRI

A

Targeted BX

35
Q

Low Risk D’Amico risk stratification

A
  1. PSA less than 10
  2. highest BX less than Gleason 6
    AND
  3. Clinical stage T2b
36
Q

Intermediate D’Amico risk stratification

A
  1. PSA between 10 - 20
  2. Highest BX 7
    OR
  3. T2b
37
Q

High D’Amico risk stratification

A

1/ PSA greater than 20
2. Highest BX Gleason 8 or higher
OR
3. Stage T2c/T3

38
Q

NCCN Risk Group Very Low

A
  1. GG 1
  2. PSA less than 10
  3. fewer than 3 cores are positive with less than 50% cancer in both
  4. PSA density less than .15
39
Q

Calculated by PSA divided by prostate volume

A

PSA density

40
Q

NCCN Risk Group Low

A
  1. GG 1
  2. PSA greater than 10
41
Q

NCCN Risk Group Intermediate/Favorable

A
  1. 1 IRF
  2. GG 1 or 2
  3. Less tha 50% of cores are positive
42
Q

NCCN Risk Group Intermediate/Unfavorable

A
  1. 2 or 3 IRF
  2. GG 3
  3. greater than 50% of BX cores are positive
43
Q

NCCN Intermediate Risk Factors 3

A
  1. T2b/T2c
  2. GG 2/3
  3. PSA between 10-20
44
Q

NCCN Risk Group High

A
  1. T3a OR
  2. GG 4/5 OR
  3. PSA greater than 20
45
Q

NCCN Risk Group Very High

A
  1. T3aor higher
  2. Gleason pattern 5 OR
  3. PSA greater than 20
46
Q

Test performed on tissue sample and provides a statistical prediction on aggressivness

A

Genomic Testing

47
Q

Decipher Score Range: Low

A

0 - .45

48
Q

Decipher Score Range High

A

.6 and 1

49
Q

Therapy that remove the entire prostate and some of the tissue around it, including the seminal vesicles

A

Radical Prostatectomy

50
Q

Pros of Radical Prostate

A

1.gold standard for all intermediate/high risk
2. Highly effective, 80% cure rate
3. Core skill for all urologists

51
Q

Cons of radical prostate

A
  1. Risks associated with surgery
  2. High morbidity
  3. Depent on surgeon skill
52
Q

According to literature, what is the reoccurance rate for Gleason 4+3

A

35%

53
Q

Benefits of Radiation Therapy

A
  1. Non-invasive
  2. non-surgical
  3. outpatient procedure
54
Q

Cons of radio therapy

A
  1. Long protocol, 6-8 weeks of daily therapy
  2. 40% failure rate
  3. High morbidity
  4. Doesnt all for second line option, kills plains and freezes pelvis
55
Q

Cons of cryotherapy

A
  1. morbidity, esspecially sexual function
  2. Percision, hard to control the extent of the iceball and going outside the ablated zone
56
Q

life expectancy for prostate cancer today

A

20 years

57
Q

LIfe expectancy for prostate cancer in 1990

A

7 years

58
Q

Advances in imaging, screening and earlier DX have changed patient value equation from A to B

A

A. Efficacy at all costs
B. Disease control with QoL

59
Q

Advanced imaging, BX and genomic testing have changed the ability to WHAT prostate cancer

A
  1. ability to localize the disease
  2. Risk stratigy prostate cancer
60
Q

Rational to adopt Focal Therapy for treatment

A
  1. provides a balence between surveillance and radical
  2. Relies on realtime, ACCURATE IMAGING
  3. Needs CONTROLLED ENERGY

Basics of Focal Therapy Slidedeck (12 decks)

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