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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
What produces prostate specific antigen?
Secretory epithelium of prostate
26
What does prostate specific antigen do?
`Help liquify semen
27
How will prostate specific antigen levels differ between normal and cancerous prostates?
Normal - high semen low serum | Cancerous - high semen high serum
28
What is the specificity and sensitivity of prostate specific antigen?
Specificity - low | Sensitivity - high
29
Which conditions elevate prostate specific antigen levels?
``` Benign prostatic hyperplasia Prostatitis UTI Retention Catheterisation Digital rectal exam ```
30
When is PSA testing indicated?
Symptomatic patients | Asymptomatic patients who've underwent counselling
31
Why is counselling mandatory prior to PSA in asymptomatic patients?
Cancer rates are very low and treatment/investigations can be associated with morbidity and lowered QoL
32
What is a TRUS biopsy? Is uncomfortable?
Trans rectal USS + biopsy | Honestly what do you think
33
What are the indications of a trans rectal US guided biopsy?
Abnormal rectal exam + raised PSA Previous abnormal biopsy Previous normal biopsy but with raised PSA
34
What are PIN and ASAP prostate biopsy results?
Prostatic intraepitherlial neoplasia | Atypical small acinar proliferation
35
How many biopsies are taken in a TRUS biopsy?
5 from each lobe of the prostate (i.e 10)
36
What are the complications of a TRUS biopsy?
Rectal bleeding Haematuria/haemospermia for 2-3 week post procedure Sepsis Vaso-vagal fainting
37
The majority of prostate cancers are what?
Multifocal adenocarcinomas
38
How does adenocarcinoma tend to spread locally?
``` Prostate capsule Urethra Bladder base Seminal vesicles Autonomic nerves ```
39
Where does prostate cancer commonly metastasis to?
Bones | Pelvic lymph nodes
40
What type of bone metastases is present in prostatic cancer?
Osteosclerotic
41
How is prostatic cancer graded? Describe this system
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
Describe the TNM classification
``` 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
How is prostatic cancer staged?
Bone scan MRI CT
44
What are the broad classifications of prostate cancer spread?
Organ confined Local spread Metastatic
45
Which factors influence management of prostate disease?
``` Category of disease Patient wishes/quality of life Life expectancy Co-morbidities Age ```
46
How is organ confined prostate cancer managed?
Watchful waiting/symptom guided (conservative > palliative) Active monitoring Radical surgery (prostatectomy) Radical radiotherapy (EBRT, brachytherapy)
47
What are the complications of prostatectomy?
Erectile dysfunction Incontinence Bladder neck stenosis
48
What are the complications of radical radiotherapy?
``` Irritative lower urinary tract symptoms Haematuira GI symptoms Erectile dysfunction Incontinence ```
49
How is locally advanced prostate disease managed?
Radiotherapy with neo-adjuvant hormonal Watchful waiting Hormonal therapy
50
Where is watchful waiting indicated in locally advanced prostate cancer?
Patient refuses treatment | Asymptomatic and well differentiated tumour with
51
When is hormonal therapy indicated in locally advanced prostate cancer?
Symptomatic with need for palliation of symptoms but with no/low change of cure
52
How is metastatic prostate cancer managed?
Androgen deprivation therapy Diethylstilbesterol/steroids Cytotoxic chemotherapy
53
List the types of androgen deprivation therapy
Hormone therapy (LHRH analogues, anti-androgens) Bilateral subcapsular orchidectomy Maximal androgen blockade
54
Which hormones influence growth of prostate cancer?
Testosterone | Dihydrotestosterone
55
Where do hormones influencing the growth of prostate cancer come form?
Adrenal | Testis
56
Testosterone induces negative feedback how?
Reduces hypothalamic LH secretion (i.e reduces LHRH)
57
What happens if prostate cells are not stimulated by androgens?
Undergo apoptosis
58
How do LHRH agonists work?
Down regulation of LHRH receptors and thus reduced secretion of FSH and LH --> reduced testosterone
59
What is testosterone surge in relation to LHRH agonists?
Initially cause an increase in LHRH and thus FSH and LH hence increased testosterone
60
What is the major serious complication of LHRH agonists? How can this be prevented?
Catastrophic spinal cord compression | Anti-androgens give one week prior and two weeks post first dose of LHRH agonists
61
What are the side effects of LHRH agonists?
``` Erectile dysfuction +/- loss of libido Weight loss Gynecomastia Cognitive change Osteoporosis Anaemia Hot flushes/sweats ```
62
How do anti-androgens work?
Compete with testosterone and dyhydrotestosterone for their binding sites within to prostate cell nucleus --> promotes apoptosis and inhibits cancer growth
63
What are the two types of anti androgens?
Steroidal (cyproterone acetate) | Non-steroidal (nilutamide, flutamide, bicalutamide)
64
What are the side effects of steroidal anti-androgens?
``` Loss of libido Erectile dysfunction Gynecomastia (rare) CVS toxicity Hepatotoxicity ```
65
What are the side effects of non-steroidal anti-androgens?
Gynecomastia Breast pain Hot flashes Hepatotoxicity
66
Do males or females more commonly get bladder cancer?
Males
67
Bladder cancer needs lifelong monitoring +/- treatment. T/F
True
68
Bladder cancer is highest in the western world. T/F
True
69
How might bladder cancer be diagnosed?
``` KUB x-ray (IV pyelogram) USS Retrograde pyelogram (if kidney damage) Cytoscopy (this) CT (this) Angiography ```
70
Are transitional cell or squamous cell carcinomas more common in the bladder?
Transitional cell (by a large margin)
71
How can transitional cell bladder cancer be categorised? Which is more common
Papillary (common) | Non-papillary
72
All transitional cell bladder cancers are infiltrative. T/F
False - some papillary cancers are not invasive malignancies but all non-papillary ones are
73
What are the type types of non-papillary bladder malignancy?
Flat non-invasive | Flat invasive
74
What is the gross appearance of transitional cell tumours on imaging?
Single lesion (small papillary vs bulky sessile) Multiple discrete Diffuse and confluent
75
Transitional cell carcinoma can present where?
Anywhere along the collecting urinary tract (i.e pelvis, ureters, bladder, urethra, etc)
76
How do papillary transitional cell carcinomas present grossly within the renal pelvis/ureters?
Stippled Multi centric and bilateral (more commonly unilateral) Synchronous vs metachronous
77
What percentage of patients with transitional cell carcinomas of the renal pelvis/ureters go on to develop bladder cancer?
50%
78
Over which age do most bladder cancers present?
60
79
Excretory urograms have been replaced by CT urography. T/F
True - excretory urograms are insensitive
80
What can sometimes be seen on imaging of urinary bladder cancer?
Halo sign
81
Which bladder tumours may calcify?
Transitional cell Sqaumous cell Urachal cell
82
What is cystica glandularis?
Metaplasia (chronic irritation of bladder mucosa)

Year 2 (72 decks)

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