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Renal and Urology > prostate and bladder cancer > Flashcards

prostate and bladder cancer Flashcards

1
Q

prostate gland is located at

A

the neck of the bladder

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2
Q

the apex of the prostate gland is

A

counter-intuitively the inferior portion of the prostate gland and is continuous with the striated sphincter

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3
Q

the base of the prostate gland is

A

superior portion of the prostate gland and is continuous with the bladder neck

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4
Q

prostatic urethra is covered by

A

transtitiola epithelium

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5
Q

what is distal to the urethral angulation

A

verumonanum

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6
Q

ejaculatory ducts are the

A

union of seminal vesicles and each vas deferens and drain to either side of the prostatic urethra

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7
Q

zonal anatomy of the prostate gland

A
  • transitional zone
  • central zone
  • peripheral zone
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8
Q

transitional zone

A

surrounds the prostatic urethra proximal to the veromontanum only 20% of prostate cancers arise here and it mostly gives rise to BPH

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9
Q

central zone

A

cone shaped region which surround the ejacultatory ducts, only 5% of prostate cancers arise in this region

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10
Q

peripheral zone

A

posteriolateral prostate where the majority of prostate cancers arise from, origin of 70% of prostatic adenocarcinoams

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11
Q

prostate cancer is rare in

A

under 50s

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12
Q

increased risk of prostate cancer if

A

you are black rather than white

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13
Q

presentation of prostate cancer

A

vast majority are asymptomatic and picked up by increased PSA levels and abnormal PR exam findings

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14
Q

what can prostate cancer sometimes cause

A

lower urinary tract symptoms such as haamaturia hamatospermia anorexia and weight loss

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15
Q

majority of prostate cancers arise from the

A

peripheral zone so can be felt on a PR exam from asymmetry, nodule or a fixed craggy mass

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16
Q

30% of patients with normal prostate specific antigen and abnormal PR exam

A

have prostate cancer

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17
Q

prostate specific antigen is a

A

glycoprotein enzyme

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18
Q

prostate specific antigen is produced by

A

the secretory epithelial cells of the prostate gland

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19
Q

PSA is involved in

A

the liquefaction of semen

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20
Q

sensitivity of PSA

A

in detecting prostate cancer is high 90% but specificity is low only 40%

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21
Q

other conditions which elevate PSA

A

BPH, PROSTATITIS, UTIS, URINARY RETENTION, CATHETERISATION, DIGITAL RECTAL EXAMINATION

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22
Q

indications for carrying out PSA levels

A
  • all symptomatic patients
  • in asymptomatic patients counselling for PSA testing should be given prior to carrying out PSA testing (i.e. you must explain that increased levels does not automatically mean prostate cancer)
23
Q

if PSA level is elevated then it requires a

A

trans-rectal ultrasound guided biopsy

24
Q

in those with elevated levels of PSA prostate cancer is present in only

A

ionly 5% of patients

25
Q

indications for trans-rectal ultrasound

A
  • abnormal DRE and increased PSA
  • Previous biopsies which show prostatic intra-epithelial neoplasia (PIEN) OR ASAP (atypical small acinar proliferation)
  • previous normal biopsies but rising PSA trends
26
Q

during a trans rectal ultrasound

A

an ultrasound is passed into the rectum and 10 biopsies are taken

27
Q

complications of a transrectla ultrasound

A

0.5% risk of sepsis, risk of recta bleeding haematospermia and haematuria occur for 2-3 weeks after the procedure

28
Q

the vast majority of prostate cancers are

A

multi-focal adenocarcinomas

29
Q

pattern of tumour growth in prostate cancer

A

extension through the prostatic capsule to the urethra and the bladder base to the seminal vesicles and with perineurial invasion along autonomic nerves

30
Q

most common sites for metastatic deposits

A

pelvic lymph nodes and the bones where it causes sclerotic lesions rather than lytic lesions

31
Q

what scoring system is used for prostate cancer

A

the gleason score

32
Q

the leasing scoring system is used to determine

A

the aggressiveness of the prostate cancer

33
Q

gleason score ranges from

A

1-5 and describes how much the tissue from the biopsy looks like healthy tissue (score of 1 is the lowest score) score of 5 is the highest and most abnormal score

34
Q

prostate tumours are often made up of

A

cancerous cells that have different grades therefore, 2 grades are assigned per tumour

35
Q

primary grade is given to the

A

cells that make up the larget part of the tumour

36
Q

secondary grade is given to the

A

cells that make up the second largest part of the tumour

37
Q

the primary grade and secondary grade are then added together to give

A

a total gleason score

38
Q

gleason scores can range from between

A

2-10 (10 being the worse)

39
Q

staging using TNM criteria

A 
T1= tumour is not palpable 
T2= tumour is palpable but confined to the prostate
T3= tumour extends through the prostate capsule
T4= tumour has invaded adjacent structure other than the seminal vesicles  
N0= no regional lymph node metastases 
N1= regional lymph node metastases 
M0= no distant metastases 
M1= distant metastases
40
Q

modalities for staging prostate cancer

A

Bone scan, CT, MRI

41
Q

broad classification of prostate cancer

A
  • organ confined disease= T1-2, NO,MO
  • locally advanced disease= T3-4, NO, MO
  • metastatic disease= N1 AND M1
42
Q

management of organ confined disease

A

option 1= active surveillance i.e. the decision not to treat the patient immediately and to follow with close surveillance and treat at pre-defined thresholds that classify progression when treatment is initiated it will be curative
option 2 = radical prostectomy
OPTION 3 = radical radiotherapy (but has complications)
option 4= conservative management of prostate cancer until it gets to a point where management is palliative appropriate in very elderly people with many co-morbidities

43
Q

complications of a radical prostectomy

A

ERECTILE DYSFUNCITON, INCONTINENCE, BLADDER NECK STNEOSIS

44
Q

complications of radical radiotherapy

A

irritatitive lower urinary tract symptoms, haeamturia, GI symptoms, erectile dysfunction, incontinence

45
Q

management of locally advanced disease

A

option 1- radiotherapy with neo-adjucvant hormonal therapy (prostate cancer depends on testoreone to grow so by blocking testosterone you can slow its growth)
option 2- watchful waiting in asymptomatic patients with well and modernly differentiated tumours who have a life expectancy of less than 10 years or using hormonal therapy in symptomatic patients but are unfit for curative treatment

46
Q

anti-hormonal therapy used

A
  • anti-androgens- bicalutamide or flutamide
  • GNRH blockers= degarelix
  • LHRH agonsits= leuprorelin
47
Q

management of metastatic disease

A
  • androgen deprivation therapy ( anti-androgens, GNRH blockers, LHRH agonists)
  • bilateral sub capsular orchidectomy
  • steroids
  • cytotoxic chemotherapy
48
Q

how do LHRH agonists work

A

chronic exposure to LHRH Agonists eventually results in down regulation of lHRH receptors which subsequently surpasses the release of LH AND FSH FROM THE PITUITARY RESULTING IN REDUCED PRODUCTION OF TESTOSTERONE

49
Q

Side effects of LHRH agonists

A

loss of libido, erectile dysfunction, hot flushes, gynaecomastia, osteoporosis

50
Q

how do anti-androgens work

A

they compete with testosterone for the and DHT for the binding site on their receptors in the prostate cells using apoptosis of the prostate cells

51
Q

types of anti-androgens

A
  • steroidal (cyproterone acetate)

- non-steroidal (nilutanide and flutanide)

52
Q

side affects of acproterone acetate

A

loss of libido, erectile dysfunction, hepatotoxic

53
Q

side effects of nilutamide and flutamide

A

gynaecomastia and hepatotoxic

Renal and Urology (51 decks)

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