Prostate and Testicular Cancer Flashcards
What is the commonest cancer in males?
Prostate
What is the majority age group for prostate cancer?
> 65yrs
Why are we now better at picking up prostate cancer?
Because more PSA tests are run
Is PSA a screening programme?
No
What are the risk factors for prostate cancer?
Age
Race/ethnicity - african caribbean men
Georgraphy - western countries
FH - 1st degree x2 risk
Which zone do prostate tumours normally affect?
Peripheral
What is the main presentation of prostate cancer?
Mostly asymptomatic
How is most prostate cancer diagnosed/picked up?
PSA
What is the diagnostic triad for prostate cancer?
PSA
Digital rectal examination
TRUS - guided prostate biopsies
Is PSA cancer specific?
no it is prostate specific but not cancer specific
What are the signs of prostate cancer locally invasive disease?
Haematuria Perineal and suprapubic pain Impotence Incontinence Loin pain Anuria
What are the signs of prostate cancer distant metastases signs?
Bone pain Sciatica Paraplegia secondary to spinal cord compression LN enlargement Lymphoedema Lethargy Weight loss
What is the commonest mode of presentation for prostate cancer?
Asymptomatic
What are the negatives for prostatic cancer screening?
Leads to over-diagnosis and over-treatment
What is PSA specific to?
Age
How does PSA vary with age?
The younger you are the lower the PSA limit
What causes elevations in PSA?
UTI
Chronic prostatitis
BPH
Prostate cancer
What is grading an assessment of?
Aggressiveness
What is grading based on?
Differentiation
Is well differentiated cancers good or bad?
Good
Is poorly differentiated cancers good or bad?
Bad
What score is used to sum all grading in prostate cancer?
6-10
What is staging an assessment of?
spreal
What are the 3 types of stages?
Local spread
Regional
Distant
What staging system is used to stage prostate cancer?
TNM
What investigations are used to stage localised prostate cancer?
PR examination PSA Transrectal US guided biopsies CT MRI
What is the treatment for localised prostate cancer?
Watchful waiting
Radiotherapy
Radical prostatectomy
Active surveillance
What are the types of radical prostatectomy?
Open
Laparoscopic
Robot
What is active surveillance?
Deference of treatment until absolutely necessary
What is watchful waiting
Monitoring for progression of next stage disease
For people who are not fit/eligable for Rx
What is the treatment for locally advanced disease?
Watchful waiting Hormone therapy follow by surgery Hormone therapy followed by radiation Hormone therapy alone Intermitted hormone therapy
What is standard treatment for locally advanced prostate cancer?
Hormone therapy followed by radiation
What are the types of hormonal therapy for prostate cancer?
Surgical castration Chemical castration Anti-androgens Oestrogen LHRH antagonists
• The following are reasonable treatment options for low-risk localised prostaste cancer except:
a) External beam radiotherapy
b) Active surveillance
c) Brachytherapy
d) Radical prostatectomy
e) Radical chemotherapy
Radical chemotherapy
• The following statements about screening for prostate cancer are true except:
a) PSA is the best available screening test
b) Compared with ad-hoc opportunistic PSA testing, screening for prostate cancer is beneficial because it saves lives
c) If screening is advocated, it should be performed for men at risk of prostate cancer rather than the entire male population
d) Screening for prostate cancer is not currently advocated
e) For suspicious cases detected by screening, there is a need to undergo a definitive test to confirm or exclude presence of prostate cancer
b. Compared to ad-hoc opportunistic PSA testing screening for prostate cancer is beneficial because it saves lives
What is the typical presentation of testicular cancer?
Usually a painless lump
What are less often presentation of testicular cancer?
Tender inflamed swelling
History of trauma
Symptoms from para-aortic LN
When is peak incidence of testicular cancer?
30 yrs
What are risk factors for testicular cancer?
Infertility
Atrophic testis
Previous cancer in contralateral testis
FH
What are some tumour markers for prostate cancer?
Alpha fetoprotein
Beta HCG
LDH/lactase dehydrogenase
What is the differential diagnosis for testicular lump?
Infection
Epididymal cyst
Missed testicular torsion
What are the investigations for testicular cancer?
MSSU
Testicular USS and CXR
Tumour markers
What is the treatment for testicular cancer?
Radical orchidectomy
Followed by surveillance
- adjuvant radiotherapy
- prophylactic chemotherapy
What is the commonest type of tumour in testicular cancer?
Germ cell tumour
How is testicular cancer staged?
CT scan chest, abdo pelvis
For testicular cancer the main lymphatic spread to regional lymph nodes occurs in which group of lymph nodes?
Para-aortic lymph nodes
