Prostate and Testicular Flashcards
What is the most commonly diagnosed cancer in males in the UK?
Prostate cancer
What is the peak age to be diagnosed with prostate cancer?
60-80
What are the definite risk factors for developing prostate cancer?
Age
Race
Family history
What are the probable and potential risk factors for developing prostate cancer?
Dietary fat intake Hormones Vasectomy Environment Diet
Which ethnicities have a higher risk for developing prostate cancer?
Caucasian and black males
What are the symptoms of local disease of prostate cancer?
Obstructive voiding symptoms
Irritative symptoms
Blocked ejaculatory ducts
Impotence
What are the symptoms of advanced/metastatic prostate cancer?
Bone pain
Anaemia
Lymphoedema
Renal failure
What are the indications for performing a PSA test?
Lower urinary tract symptoms suggestive of BPH
Abnormal prostate on DRE
Patient concerned about prostate cancer
When should a PSA test not be performed?
In presence of retention or infection
Less than 10-year life expectancy
After instrumentation to lower urinary tract (e.g. catheter)
What three methods can be used to detect prostate cancer?
DRE
PSA test
Transurethral ultrasound scan
What factors determine treatment of prostate cancer?
Gleason grade
TNM stage
PSA level
What can be used to treat skeletal complications in hormone refractory prostate cancer?
Bisphosphonates
What do bisphosphonates do?
Inhibit osteoclast formation, migration and osteolytic activity
Modulate signalling from osteoblasts to osteoclasts
What are the subtypes of testicular cancer?
Germ cell tumours (95%)
Non-germ cell tumours (5%)
What are the two main types of testicular germ cell tumour?
Seminoma
Non-seminoma (eg teratoma)
What is the age range of diagnosis of testicular germ cell tumours?
15-35
What do testicular tumours of older men tend to be?
Spermatocytic seminomas
Testicular lymphomas
What are the risk factors for testicular germ cell tumours?
Cryptorchidism Testicular atrophy Inguinal hernia Hydrocoele Syndromes with abnormal testicular development
Testicular cancer is associated with being exposed to high levels of what hormone?
Oestrogen
What is testicular carcinoma in situ?
Testicular intraepithelial neoplasia
A precursor for testicular cancer
What is the typical symptom that presents with testicular cancer?
Painless swelling of the testis
10% of testicular germ cell tumours present with metastases. What symptoms would you see with this?
Respiratory symptoms: Haemoptysis, cough GI: nausea, haemorrhage Neurological: CNS, PNS Lumbar back pain Lower limb swelling
How would you investigate a testicular cancer?
Physical examination
Scrotal ultrasound
Serum tumour marker blood tests
What are the serum tumour marker blood tests that should be done for testicular cancer?
Alpha-fetoprotein
Beta-human chorionic gonadotropin
Lactate dehydrogenase
Which serum tumour markers are normally elevated in non-seminoma germ cell tumours?
Either AFP or beta-hCG, or both
Which serum tumour marker is normally elevated in seminomas?
LDH
What is the treatment for a testicular cancer/tumour?
Radical orchidectomy
When should a contralateral biopsy be offered?
Testicular volume less than 12cc
History of cryptorchidism
Age under 30
What are the subclassifications of testicular masses?
Intra-testicular
Extra-testicular
Which of the two subclassifications of testicular masses tend to be benign?
Extra-testicular
What can intra-testicular masses be due to?
Malignant primary or secondary tumours Benign tumours Infection Trauma Torsion
What can extra-testicular masses be due to?
Hydrocoele Epididymal cyst Spermatocoeles Varicocoele Epididymitis/orchitis
Why should undescended testes be treated promptly?
Prevent atrophy
Maintain fertility
What risk do small atrophic testicles carry?
Increased risk of malignancy
