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Year 2 > Prostate and bladder cancer > Flashcards

Prostate and bladder cancer Flashcards

1
Q

What is the apex of the prostate?

A

Inferior pole (continuous with striated sphincter)

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2
Q

What is the base of the prostate?

A

Superior pole (continuous with bladder neck)

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3
Q

What type of epithelium composes the prostatic urethra?

A

Transitional

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4
Q

What is the vermontanum (seminal colliculus)?

A

Part of urethra distal to urethral angulation where the ejaculatory ducts drain

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5
Q

What are the ejaculatory ducts?

A

Joint vas deferans and seminal vesicles

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6
Q

What are the zones of the prostate?

A

Transitional
Central
Peripheral

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7
Q

Where is the transitional zone of the prostate

A

Surrounds prostatic distal to vermontanum

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8
Q

What common pathologies arise from the transitional zone of the prostate?

A 
Prostate cancer (10-20%)
Benign prostatic hyperplasia
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9
Q

Where is the central zone of the prostate?

A

Cone shaped region that surrounds the ejaculatory ducts

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10
Q

What pathology arises from the central zone of the prostate?

A

Prostate cancer (very rarely)

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11
Q

Where is the peripheral zone of the prostate?

A

Posterolateral

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12
Q

Which zone of the prostate is the biggest?

A

Peripheral zone (composes most of the tissue)

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13
Q

What pathology arises from the peripheral zone of the prostate?

A

Prostatic adenocarcinoma (majority)

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14
Q

The prostate has fibromuscular stroma which for some reason isn’t listed as one of the zones thank fuck for podcast lectures am i right. T/F

A

True - cannot be palpated on examination as it is anterior

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15
Q

What is the most common malignancy affecting males in the UK?

A

Prostate

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16
Q

Is mortality high in relation to prostate cancer?

A

Yes

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17
Q

Which screening test is used to detect prostate cancer?

A

Prostate specific antigen

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18
Q

What is the natural history of prostate cancer?

A

Long, indolent course

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19
Q

What are the risk factors associated with prostatic cancer?

A

Age (>50)
Western world
Black men
Family history

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20
Q

How does prostatic cancer present?

A 
Majority asymptomatic 
Lower urinary tract symptoms
Haematuria
Haematospermia 
Bone pain (night)
Anorexia
Weight loss
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21
Q

How is asymptomatic prostate cancer picked up?

A

Prostate specific antigen

Digital rectal exam

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22
Q

How does prostate cancer present on rectal exam?

A

Asymmetry
Nodule
Fixed craggy mass

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23
Q

By the time prostate cancer is picked up most patients will have metastases. T/F

A

True

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24
Q

What is prostate specific antigen?

A

Glycoprotein enzyme

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25
Q

What produces prostate specific antigen?

A

Secretory epithelium of prostate

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26
Q

What does prostate specific antigen do?

A

`Help liquify semen

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27
Q

How will prostate specific antigen levels differ between normal and cancerous prostates?

A

Normal - high semen low serum

Cancerous - high semen high serum

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28
Q

What is the specificity and sensitivity of prostate specific antigen?

A

Specificity - low

Sensitivity - high

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29
Q

Which conditions elevate prostate specific antigen levels?

A 
Benign prostatic hyperplasia 
Prostatitis
UTI
Retention 
Catheterisation
Digital rectal exam
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30
Q

When is PSA testing indicated?

A

Symptomatic patients

Asymptomatic patients who’ve underwent counselling

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31
Q

Why is counselling mandatory prior to PSA in asymptomatic patients?

A

Cancer rates are very low and treatment/investigations can be associated with morbidity and lowered QoL

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32
Q

What is a TRUS biopsy? Is uncomfortable?

A

Trans rectal USS + biopsy

Honestly what do you think

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33
Q

What are the indications of a trans rectal US guided biopsy?

A

Abnormal rectal exam + raised PSA
Previous abnormal biopsy
Previous normal biopsy but with raised PSA

34
Q

What are PIN and ASAP prostate biopsy results?

A

Prostatic intraepitherlial neoplasia

Atypical small acinar proliferation

35
Q

How many biopsies are taken in a TRUS biopsy?

A

5 from each lobe of the prostate (i.e 10)

36
Q

What are the complications of a TRUS biopsy?

A

Rectal bleeding
Haematuria/haemospermia for 2-3 week post procedure
Sepsis
Vaso-vagal fainting

37
Q

The majority of prostate cancers are what?

A

Multifocal adenocarcinomas

38
Q

How does adenocarcinoma tend to spread locally?

A 
Prostate capsule
Urethra
Bladder base
Seminal vesicles 
Autonomic nerves
39
Q

Where does prostate cancer commonly metastasis to?

A

Bones

Pelvic lymph nodes

40
Q

What type of bone metastases is present in prostatic cancer?

A

Osteosclerotic

41
Q

How is prostatic cancer graded? Describe this system

A

Gleason’s score
Based on architectural appearance of prostate gland
- Initial feature of malignancy is loss of basement membrane –>
- Progressive loss of glandular structure and replacement by malignant growth –>
- Abundant cell patterns assessed then added to give score

42
Q

Describe the TNM classification

A 
T 
 - 1 clinically inapparent
 - 2 confined to prostate 
 - 3 extension through capsule
 - 4 local spread 
N 
 - 0 no nodes
 - 1 regional nodes
M
 - 0 no distant metastases
 - 1 distant metastases
43
Q

How is prostatic cancer staged?

A

Bone scan
MRI
CT

44
Q

What are the broad classifications of prostate cancer spread?

A

Organ confined
Local spread
Metastatic

45
Q

Which factors influence management of prostate disease?

A 
Category of disease
Patient wishes/quality of life 
Life expectancy 
Co-morbidities
Age
46
Q

How is organ confined prostate cancer managed?

A

Watchful waiting/symptom guided (conservative > palliative)
Active monitoring
Radical surgery (prostatectomy)
Radical radiotherapy (EBRT, brachytherapy)

47
Q

What are the complications of prostatectomy?

A

Erectile dysfunction
Incontinence
Bladder neck stenosis

48
Q

What are the complications of radical radiotherapy?

A 
Irritative lower urinary tract symptoms 
Haematuira
GI symptoms
Erectile dysfunction
Incontinence
49
Q

How is locally advanced prostate disease managed?

A

Radiotherapy with neo-adjuvant hormonal
Watchful waiting
Hormonal therapy

50
Q

Where is watchful waiting indicated in locally advanced prostate cancer?

A

Patient refuses treatment

Asymptomatic and well differentiated tumour with

51
Q

When is hormonal therapy indicated in locally advanced prostate cancer?

A

Symptomatic with need for palliation of symptoms but with no/low change of cure

52
Q

How is metastatic prostate cancer managed?

A

Androgen deprivation therapy
Diethylstilbesterol/steroids
Cytotoxic chemotherapy

53
Q

List the types of androgen deprivation therapy

A

Hormone therapy (LHRH analogues, anti-androgens)
Bilateral subcapsular orchidectomy
Maximal androgen blockade

54
Q

Which hormones influence growth of prostate cancer?

A

Testosterone

Dihydrotestosterone

55
Q

Where do hormones influencing the growth of prostate cancer come form?

A

Adrenal

Testis

56
Q

Testosterone induces negative feedback how?

A

Reduces hypothalamic LH secretion (i.e reduces LHRH)

57
Q

What happens if prostate cells are not stimulated by androgens?

A

Undergo apoptosis

58
Q

How do LHRH agonists work?

A

Down regulation of LHRH receptors and thus reduced secretion of FSH and LH –> reduced testosterone

59
Q

What is testosterone surge in relation to LHRH agonists?

A

Initially cause an increase in LHRH and thus FSH and LH hence increased testosterone

60
Q

What is the major serious complication of LHRH agonists? How can this be prevented?

A

Catastrophic spinal cord compression

Anti-androgens give one week prior and two weeks post first dose of LHRH agonists

61
Q

What are the side effects of LHRH agonists?

A 
Erectile dysfuction +/- loss of libido
Weight loss
Gynecomastia
Cognitive change
Osteoporosis
Anaemia 
Hot flushes/sweats
62
Q

How do anti-androgens work?

A

Compete with testosterone and dyhydrotestosterone for their binding sites within to prostate cell nucleus –> promotes apoptosis and inhibits cancer growth

63
Q

What are the two types of anti androgens?

A

Steroidal (cyproterone acetate)

Non-steroidal (nilutamide, flutamide, bicalutamide)

64
Q

What are the side effects of steroidal anti-androgens?

A 
Loss of libido
Erectile dysfunction
Gynecomastia (rare)
CVS toxicity
Hepatotoxicity
65
Q

What are the side effects of non-steroidal anti-androgens?

A

Gynecomastia
Breast pain
Hot flashes
Hepatotoxicity

66
Q

Do males or females more commonly get bladder cancer?

A

Males

67
Q

Bladder cancer needs lifelong monitoring +/- treatment. T/F

A

True

68
Q

Bladder cancer is highest in the western world. T/F

A

True

69
Q

How might bladder cancer be diagnosed?

A 
KUB x-ray (IV pyelogram)
USS
Retrograde pyelogram (if kidney damage)
Cytoscopy (this)
CT (this)
Angiography
70
Q

Are transitional cell or squamous cell carcinomas more common in the bladder?

A

Transitional cell (by a large margin)

71
Q

How can transitional cell bladder cancer be categorised? Which is more common

A

Papillary (common)

Non-papillary

72
Q

All transitional cell bladder cancers are infiltrative. T/F

A

False - some papillary cancers are not invasive malignancies but all non-papillary ones are

73
Q

What are the type types of non-papillary bladder malignancy?

A

Flat non-invasive

Flat invasive

74
Q

What is the gross appearance of transitional cell tumours on imaging?

A

Single lesion (small papillary vs bulky sessile)
Multiple discrete
Diffuse and confluent

75
Q

Transitional cell carcinoma can present where?

A

Anywhere along the collecting urinary tract (i.e pelvis, ureters, bladder, urethra, etc)

76
Q

How do papillary transitional cell carcinomas present grossly within the renal pelvis/ureters?

A

Stippled
Multi centric and bilateral (more commonly unilateral)
Synchronous vs metachronous

77
Q

What percentage of patients with transitional cell carcinomas of the renal pelvis/ureters go on to develop bladder cancer?

A

50%

78
Q

Over which age do most bladder cancers present?

A

60

79
Q

Excretory urograms have been replaced by CT urography. T/F

A

True - excretory urograms are insensitive

80
Q

What can sometimes be seen on imaging of urinary bladder cancer?

A

Halo sign

81
Q

Which bladder tumours may calcify?

A

Transitional cell
Sqaumous cell
Urachal cell

82
Q

What is cystica glandularis?

A

Metaplasia (chronic irritation of bladder mucosa)

Year 2 (72 decks)

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