Prostate and Kidney Cancer (one lecture) Flashcards
Risk factors for prostate cancer
- increasing age (>50)
- diet (high fat)
- family history
- race (african american)
What are the different screening methods for prostate cancer?
- Digital rectal exam
- PSA
What are the general methods of treating prostate cancer? (4) (if it is confined to the prostate)
- active surveillance (recommended for 2/3 of new cases)
- radical prostatectomy
- external beam radiation
- brachytherapy (radioactive seeds - much less complication than external beam)
** for metastatic cancer: orchiectomy/ medical castration (deprivation of androgens)
T/F - early stage prostate cancer can impact the urethra - causing decreased stream
false. it doesn’t affect urethra early on - because it starts in the peripheral zone
symptoms of early prostatic disease
none
symptoms of progressive prostatic disease
- hesitancy, decreased stream, nocturia
- blood in semen
- impotence
- bone pain (advanced)
What is prostate-specific antigen (PSA)?
it is a serine protease which liquefies ejaculate. It is prostate specific but NOT cancer - specific.
Ways to enhance PSA specificity
- use age-matched reference values (PSA rises with age)
- measure PSA velocity (>0.75/year rise = suspicious)
- measure PSA density (>0.15 = suspicious for cancer)
- measure % free PSA (low % free is bad)
T/F - digital rectal exam can raise someone’s PSA
FALSE
T/F: prostate cancer is generally over-diagnosed and over-treated
true. Screening has not been shown to reduce death rate.
T/F: in certain studies, prostate screening with PSA was associated with increased mortality
true. (PLCO trial) other trials show benefit.
PLCO trial had many confounders - they were allowed to have 1 prior PSA.. and they had no age-matched reference… plus 50% of people got PSAs outside of the study.
Overview of complexities in PLCO trial (showed PSA screening associated with increased death rate)
PLCO trial had many confounders - they were allowed to have 1 prior PSA.. and they had no age-matched reference… plus 50% of people got PSAs outside of the study.
benefits of screening for prostate cancer
-catch it earlier, more localized
Who should be screened for prostate cancer?
- Screen 55-69 - prime age, and age where treatment makes the biggest difference
- Screen 40-55 years if other risk factors (family history, African American)
- DO NOT screen under 40 years.
T/F Patients with lower urinary tract symptoms should be checked for PSA.
True.
If someone has elevated PSA or a positive digital rectal exam, what is the next step?
-get a transurethral ultrasound-guided biopsy
Most common site of metastasis for prostate cancer
lumbar spine
T/F: transurethral ultrasound of the prostate is a reasonable alternative to PSA screening.
False. It is not a screening method.
epidemiology of kidney cancer
- Renal Cell Carcinoma (RCC) makes up 85-90% of all primary renal neoplasms. Typically gray, spherical mass on CT
- 3% of all adult cancer deaths in the USA
- males more common than females
- quite fatal (1/3 die of the disease and 1/4 have metastatic disease at birth)
risk factors for kidney cancer (6)
- Cigarrette smoking
- Obesity
- hypertension
- renal cystic disease (in end stage renal disease)
- Family syndromes - Von Hippel Lindau and Tuberous sclerosis.
differential diagnosis for a solid renal mass
- Renal Cell Carcinoma until proven otherwise! (70-85% of all renal masses)
- oncocytomas (identical to RCC)
- angiomyolipomas (fat density (black shading) by CT)
- urothelial carcinoma
Less common:
- metastasis to the kidney
- renal abscess (if fever)
- adrenal tumor
- lymphoma
What are the different histologic subtypes of renal cancer?
Malignant
- clear cell (85% of RCC) - most common
- papillary = second most common
- chromophobe
Benign
- oncocytoma
- angiomyolipoma
Workup for new onset renal cancer - what does it consist of ?
CT scan with contrast = best test. (ultrasound should not be used on its own, but may help determine if cystic.)
Staging system overview for renal cancer
T1 = confined to kidney, 7cm
T3 - into major veins or perinephric tissue
T4 = beyond Gerota’s fascia
What are the two major treatment options for renal cancer?
Surgery is the mainstay of treatment.
*Partial nephrectomy (more commonly done, preserves renal fxn, less morbidity/mortality)
*Radical nephrectomy (take the whole kidney out - rarely done now)
Note: also, laparoscopic cryotherapy/ ablation also available.
T/F - 50% of renal masses are detected incidentally
True!!
classic triad for renal cancer
-flank pain
-palpable mass
-hematuria
this occurs in
T/F: Paraneoplastic syndromes are common in kidney cancer.
True. PTH-rp is produced in 10% of tumors, while EPO is produced in 5% of tumors
Renal cancer workup for metastatic disease
- CXR
- bone scan if elevated alk phos or bone pain
- LFTs, serum calcium, CBC
- head CT/MRI if symptoms or widely metastatic disease
T/F Renal biopsy is part of the workup for kidney cancer.
False. Generally not done
T/F Renal biopsy is always done before removing the kidney in the case of a renal mass.
FALSE. Not done for large tumors - they just take it out (complications from biopsy, many times indecisive, may miss tumor. Just take the kidney out instead)..
However, it may be done for small tumors, suspected lymphoma, or high surgical risk pts)
T/F: Despite not being curative, taking out the kidney improves survival in metastatic renal cancer.
True.
