Prostate and Testicular Cancer

Question 1

What is the commonest cancer in males?

Answer 1

Prostate

Question 2

What is the majority age group for prostate cancer?

Answer 2

> 65yrs

Question 3

Why are we now better at picking up prostate cancer?

Answer 3

Because more PSA tests are run

Question 4

Is PSA a screening programme?

Answer 4

No

Question 5

What are the risk factors for prostate cancer?

Answer 5

Age
Race/ethnicity - african caribbean men
Georgraphy - western countries
FH - 1st degree x2 risk

Question 6

Which zone do prostate tumours normally affect?

Answer 6

Peripheral

Question 7

What is the main presentation of prostate cancer?

Answer 7

Mostly asymptomatic

Question 8

How is most prostate cancer diagnosed/picked up?

Answer 8

PSA

Question 9

What is the diagnostic triad for prostate cancer?

Answer 9

PSA
Digital rectal examination
TRUS - guided prostate biopsies

Question 10

Is PSA cancer specific?

Answer 10

no it is prostate specific but not cancer specific

Question 11

What are the signs of prostate cancer locally invasive disease?

Answer 11

Haematuria 
Perineal and suprapubic pain 
Impotence
Incontinence
Loin pain 
Anuria

Question 12

What are the signs of prostate cancer distant metastases signs?

Answer 12

Bone pain 
Sciatica 
Paraplegia secondary to spinal cord compression 
LN enlargement 
Lymphoedema
Lethargy 
Weight loss

Question 13

What is the commonest mode of presentation for prostate cancer?

Answer 13

Asymptomatic

Question 14

What are the negatives for prostatic cancer screening?

Answer 14

Leads to over-diagnosis and over-treatment

Question 15

What is PSA specific to?

Answer 15

Age

Question 16

How does PSA vary with age?

Answer 16

The younger you are the lower the PSA limit

Question 17

What causes elevations in PSA?

Answer 17

UTI
Chronic prostatitis
BPH
Prostate cancer

Question 18

What is grading an assessment of?

Answer 18

Aggressiveness

Question 19

What is grading based on?

Answer 19

Differentiation

Question 20

Is well differentiated cancers good or bad?

Answer 20

Good

Question 21

Is poorly differentiated cancers good or bad?

Answer 21

Bad

Question 22

What score is used to sum all grading in prostate cancer?

Answer 22

6-10

Question 23

What is staging an assessment of?

Answer 23

spreal

Question 24

What are the 3 types of stages?

Answer 24

Local spread
Regional
Distant

Question 25

What staging system is used to stage prostate cancer?

Answer 25

TNM

Question 26

What investigations are used to stage localised prostate cancer?

Answer 26

``` PR examination PSA Transrectal US guided biopsies CT MRI ```

Question 27

What is the treatment for localised prostate cancer?

Answer 27

Watchful waiting Radiotherapy Radical prostatectomy Active surveillance

Question 28

What are the types of radical prostatectomy?

Answer 28

Open Laparoscopic Robot

Question 29

What is active surveillance?

Answer 29

Deference of treatment until absolutely necessary

Question 30

What is watchful waiting

Answer 30

Monitoring for progression of next stage disease | For people who are not fit/eligable for Rx

Question 31

What is the treatment for locally advanced disease?

Answer 31

``` Watchful waiting Hormone therapy follow by surgery Hormone therapy followed by radiation Hormone therapy alone Intermitted hormone therapy ```

Question 32

What is standard treatment for locally advanced prostate cancer?

Answer 32

Hormone therapy followed by radiation

Question 33

What are the types of hormonal therapy for prostate cancer?

Answer 33

``` Surgical castration Chemical castration Anti-androgens Oestrogen LHRH antagonists ```

Question 34

• 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

Answer 34

Radical chemotherapy

Question 35

• 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

Answer 35

b. Compared to ad-hoc opportunistic PSA testing screening for prostate cancer is beneficial because it saves lives

Question 36

What is the typical presentation of testicular cancer?

Answer 36

Usually a painless lump

Question 37

What are less often presentation of testicular cancer?

Answer 37

Tender inflamed swelling History of trauma Symptoms from para-aortic LN

Question 38

When is peak incidence of testicular cancer?

Answer 38

30 yrs

Question 39

What are risk factors for testicular cancer?

Answer 39

Infertility Atrophic testis Previous cancer in contralateral testis FH

Question 40

What are some tumour markers for prostate cancer?

Answer 40

Alpha fetoprotein Beta HCG LDH/lactase dehydrogenase

Question 41

What is the differential diagnosis for testicular lump?

Answer 41

Infection Epididymal cyst Missed testicular torsion

Question 42

What are the investigations for testicular cancer?

Answer 42

MSSU Testicular USS and CXR Tumour markers

Question 43

What is the treatment for testicular cancer?

Answer 43

Radical orchidectomy Followed by surveillance - adjuvant radiotherapy - prophylactic chemotherapy

Question 44

What is the commonest type of tumour in testicular cancer?

Answer 44

Germ cell tumour

Question 45

How is testicular cancer staged?

Answer 45

CT scan chest, abdo pelvis

Question 46

For testicular cancer the main lymphatic spread to regional lymph nodes occurs in which group of lymph nodes?

Answer 46

Para-aortic lymph nodes