Prostate and bladder cancer Flashcards
What are the three zones of the prostate, in order of where most cancers arise from
Peripheral, transitional, central
Where is the majority of the glandular tissue in the prostate located?
Peripheral zone
How does prostate cancer present?
Majority- asymptomatic, picked up incidentally
Symptomatic- nocturia, hesitancy, poor stream, terminal dribbling, obstruction.
Also- weight loss and bone pain may suggest mets
What is prostate specific antigen?
Glycoprotein, involved in the liquefication of semen
What is PSA’s use as a marker for prostate disease limited by?
Low specificity- also raised in UTI, BPH, retention
What invasive investigation may be used when a patient has an abnormal DRE and/or raised PSA? What are the risks of this procedure?
Transrectal USS-guided biopsy. 1% risk of either sepsis or significant bleeding
What is the histological subtype of most prostate cancers?
Adenocarcinoma
Where do prostate cancers spread a) locally and b) distantly?
a) urethra, bladder, seminal vesicles, rectum
b) bone- sclerotic lesions
What imaging modalities are used in the staging of prostate cancer?
Bone scan, MRI, CT
What are the options for treatment of organ-confined prostatic carcinoma?
Watchful waiting and monitoring of PSA
Prostatectomy
Radiotherapy
What are the possible post-surgical complications of prostatic carcinoma?
ED; bladder neck stenosis; incontinence
How is metastatic prostate cancer managed?
Hormonal blockade:
- LHRH agonists (causes an initial surge in pituitary gonadotrophin relase, then inhibit)
- Anti-androgens (also used to give “cover” during initial phase of LHRH agonists)
- Orchidectomy
What constitutes the vast majority of bladder cancers in the West?
Transitional cell carcinomas
How does bladder cancer present?
Painless haematuria; recurrent UTI; voiding irritability
What imaging studies/modalities are used in the diagnosis of bladder cancer?
Intravenous urography
CT
Cystoscopy
