Prostate and Bladder cancer Flashcards
how much should a prostate weigh in a young adult
20 grams
what cell type covers the prostatic urethra
transitional epithelium
what are the apex and base of the prostate continuous with
apex= inferior portions of the prostate, continuous with the striated sphincter
base= superior portion= continuous with the bladder neck
what are the zones of the prostate
transitional (surrounds prostatic urethra)
central (surrounds ejaculatory ducts)
peripheral zone (majority of prostate glandular tissue, posteriolatera; prostate)
where is prostate does BPH arise from
transitional zone
where do 70% of prostate adenocarcinomas originate from
the peripheral zone
how common is prostate cancer
most common in UK for men
what is the peak of for prostate cancer
70-74 years
who is most at risk of prostate cancer
black men
western world (scandinavia and north america)
FH
what is the presentation of prostate cancer
vast majority asymptomatic (found by PSA (raised) and abnormal DRE findings)
can have lower urinary tract symptoms
haematuria/ haematospermia
bone pain, anorexia, weight loss
what are the findings on DRE of prostate cancer
asymmetry
nodule
fixed craggy mass
is PSA definitive for prostate cancer
no can be raised by anything that inflamed the prostate
some patients with prostate cancer will have a normal PSA
what is PSA
a glycoprotein enzyme produced by the secretory pithelial cells of the prostate gland
-involved with the liquidation of semen
what are PSA levels meant be
normal= semen PSA high, serum low
in prostate cancer the serum PSA rises
what else can elevate PSA
BPH prostatitis/ UTIs retention catheterisation DRA
what is mandatory for asymptomatic patients before a PSA test
counselling:
Cancer identified in <5% of patients
Sensitivity-80-90%
Specificity- 40%
when would you do a trans-rectal USS guided prostate biopsy
abnormal DRE and raised PSA
previous abnormal biopsy
normal biopsy but rising PSA trend
what are the risk with trans rectal biopsys
(10 biopsies should be taken)
- sepsis
- rectal bleeding
- vaso-vagal fainting
- haematospermia and haematuria
what are the majority of prostate cancers
multifocal adenocarciomas
how do prostate cancers spread
through prostatic capsule urethra bladder base seminal vesicals perineural invasion along autonomic nerves
most common mets sites:
- pelvic lymph nodes
- skeleton
what lesions are characteristic of prostate cancer
sclerotic lesions
what is a predictor of prostate cancer prognosis
gleasons scoring (used to grade cancers)
what imaging to stage prostate cancer
bone scan
MRI
CT scan
what are the broad classifications of prostate cancer
organ confined:
-T1-2 N0 M0
locally advanced
-T3-4 N0 M0
metastatic
- N+ M+
what is the management for organ confined prostate cancer
watchful waiting/ symptom guided treatment (treated palliatively when systemic progression)
active surveillance with curative treatments:
- radical surgery
- radical radiotherapy
what are the management options for locally advanced prostate cancer
radiotherapy with neo-adjuvant hormonal therapy
watchful waiting (asymptomatic patients with LE< 10/ dont accept treatment complications)
hormonal therapy (symptomatic patients who need palliation, unfit for curative Tx)
what is the management for metastatic prostate cancer
androgen deprivation therapy
- hormonal (LHRH analogues, anti-androgens)
- bilateral orchidectomy
- maximal androgen blockage
steroids/ diethylstilbesterol
cytotoxic chemotherapy
how can you hormonally control the prostate
growth of prostate cancer cells under the influence of testosterone and dihydrotestosterone (from testes 90%, and adrenals)
if prostate cells are deprived of adrogenic stimulation then undergo apoptosis
- LHRH agonists (down regulates LHRH receptors, suppresses pituitary LH and FSH secretion and therefore testosterone secretion)
- anti-androgens (compeitive inhibition) (can be steroidal or non steroidal)
what are the side effects of LHRH agonists
loss of libido, ED hot flushes and sweats weight gain gynaecomastia anaemia cognitive changes osteoporosis
how do you diagnose prostate cancer
PSA and DRE
how do you diagnose bladder cancer
flexible cystoscopy and CT scan
what are the main types of bladder cancer
= uroepithelial (can be split into)
- transitional cell 90%
squamous cell 9%
how do you classify transitional cell carcinoma
papillary 80% (50% are infiltrative malignancies)
non papillary 20% (all considered to be malignant) (are flat, can be invasive or non invasive)
how can you image bladder cancer
excretory urogram sonography retrograde pyelogram computed tomography angiography
what do transitional cell bladder cancers look like
stippled appearance
have outward projections
tend to be multicentric and bilateral
what will half of patients with cancer of ureter/ renal pelvis develop
bladder carcinoma
who gets bladder cancer
M4:F1
after 5th decade of life
what scan is insensitive for diagnosis of urinary bladder carcinoma
excretory urography
what signs can be associated with bladder cancer
urinary bladder halo sign
