Prostate and Testicular Cancer

Question 1

What are the risk factors for prostate cancer?

Answer 1

Age

Race/Ethnicity
- African or Afro-Caribbean men living in Western countries
vs East Asian or Asian men living in Western countries

Geography
- Northwest Europe/North America/Caribbean/ Australia vs Asia/Africa/Central & South America

Family history
	- first degree relative 2x risk
	- HPC1; BRCA1 & 2
Foods like Vit E and omega 3 fatty acid
Drugs like finasteride and dutasteride

Question 2

Name four Mcneal zones of the prostate

Answer 2

Transition
Central
Anterior fibromuscular stroma
Peripheral (affected by cancer)

Question 3

What are the normal PSA ranges for different ages?

Answer 3

Normal serum range 0-4.0g/mL
Age-related range - Levels increase with age
< 50 years : 2.5 is upper limit
50-60 years : 3.5 is upper limit
60-70 years : 4.5 is upper limit
>70 years : 6.5 is upper limit

Question 4

What things can lead to elevated PSA?

Answer 4

UTI
Chronic prostatitis
Instrumentation (e.g. catheterisation)
Physiological (e.g. ejaculation)
Recent urological procedure
BPH
Prostate cancer

Question 5

How long should be left between PSA testing if it needs to be repeated?

Answer 5

3 weeks

8 half lives

Question 6

What are possible treatments for prostate cancer?

Answer 6

Watchful waiting
Radiotherapy
-External-beam
-Brachytherapy
Radical prostatectomy
-Open
-Laparoscopic
-Robotic
Others under investigation
-Cryotherapy
-Thermotherapy

Question 7

What are different types of hormone therapy for prostate cancer?

Answer 7

Surgical castration (i.e. bilateral orchidectomy)

Chemical castration (i.e. LHRH analogue – goserelin, leuprorelin, etc.)
eventually downregulates androgen receptors by negative feedback
tumour flare in first week of therapy (hence need anti-androgen during this period)

Anti-androgens
inhibits androgen receptors

Oestrogens (i.e. diethylstilboestrol)
inhibits LHRH and testosterone secretion, inactivates androgens and has direct cytotoxic effect on prostatic epithelial cells

Question 8

What is the presentation for testicular cancer?

Answer 8

Painless lump
Tender inflamed swelling
History of trauma (although trauma NOT a risk factor)
Symptoms/signs from nodal or distant metastasis
- para-aortic lymph nodes
- chest
- bone

Question 9

What are the risk factors for testicular cancer?

Answer 9

Racial - higher risk in Caucasians

Risk higher in testicular maldescent; infertility; atrophic testis; and previous cancer in contralateral testis

Question 10

What are the tumour markers that should be tested for in bloods for testicular cancer?

Answer 10

AFP (alpha-fetoprotein) (teratoma)
HCG (Human Chorionic Gonadotrophin) (seminoma)
LDH (Lactate dehydrogenase) (non-specific marker of tumour burden)

Question 11

What investigations should be done for testicular cancer?

Answer 11

MSSU
Testicular ultrasound scan and CXR
Tumour markers

Question 12

What are some types of testicular tumours?

Answer 12

GCT:
Seminomatous GCT (classical, spermatocytic, or anaplastic)
Non-seminomatous GCT (teratoma, yolk sac, choriocarcinoma, mixed GCT)

Non-GCT (sex cord/stromal):
Leydig
Sertoli
Lymphoma rare