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urinary > Prostate and testicular cancers > Flashcards

Prostate and testicular cancers Flashcards

1
Q

Describe prostate location in relation to other organs

A

Bladder is superior to the prostate - urethra is inferior to the prostate - rectum is posterior to the prostate - pubic bone is anterior to the prostate

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2
Q

Who is most at risk of prostate cancer

A

Older men, afro-carribean ethnicity and people with a first degree relative - genes associated are HPC1 and BRCA1+2
People with a first degree relative have double the risk
Being overweight - 10% increased risk for every 5 BMI points

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3
Q

What part of the prostate is most commonly seen with cancer

A

peripheral zone where it can be palpated in the digital rectal exam

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4
Q

What is PSA and what does it mean to have a high PSA

A

Prostate specific antigen - if it is raised, it suggests that there is a higher chance of prostate cancer but it doesn’t guarantee it

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5
Q

What percentage of prostate cancers are diagnosed when they are localised

A

80%

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6
Q

What are the symptoms which people with localised prostate cancer present with

A

weak stream - hesitancy - feeling of incomplete emptying - frequency - urgency with or without urge incontinence and UTI

the majority dont have cancer symptoms but have LUTS

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7
Q

What are the symptoms of locally invasive prostate cancer

A

Haematuria - perineal and suprapubic pain - impotence - incontinence - renal failure symotins -haemospermia and rectal symptoms including tenesmus - the feeling of needing to pass stool even though you don’t need to

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8
Q

What are the Distant metastases symptoms

A

Bone pain and lymph node enlargement

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9
Q

What are Widespread metastases symptoms

A

lethargy and weight loss due to cachexia - wakness and wasting of the body due to illness

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10
Q

What is the commonest presentation of prostate cancer

A

Asymptomatic

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11
Q

What is the trend between age and PSA

A

PSA increases with age

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12
Q

What can cause an elevation in PSA

A

UTI, Chronic prostatitis, catheterisation, ejaculation, BPH and prostate cancer

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13
Q

How to differentiate between transient vs persistent rise in PSA

A

Recheck the PSA after 3 weeks of the first check

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14
Q

What is done if Digital rectal exam is abnormal or PSA is raised

A

MRI scan is done to identify which parts of the prostate to biopsy - MRI does not confirm prostate cancer but guides biopsies and gives levels of suspicion - MRI can also help with staging T and N

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15
Q

How is the biopsy of the prostate performed

A

TRUS- guided - trans rectal ultrasound guided biopsy

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16
Q

What is AD hoc PSA testing

A

Where only certain individuals are screened

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17
Q

What is the grading of a tumour

A

How aggressive the tumour is - using histology and biopsies are required

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18
Q

What is the staging of a tumour

A

An assessment of the spread of the tumour - using imaging and clinical exams such as PSA and DRE

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19
Q

What scoring system is used to grade prostate cancer

A

Gleason sum score

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20
Q

What are the categories of staging

A

localised, locally advanced, metastatic and castrate-resistant/hormone refractory stage

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21
Q

how does Gleason sum grading system work

A

if the histology is showing a mix the Gleason is the largest and second largest areas

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22
Q

What is done to stage prostate cancer

A

DRE - digital rectal exam - T
PSA
MRI - T
CT - N+M
Bone scan - M

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23
Q

What does T1 mean in localised prostate cancer by digital rectal exam

A

impalpable disease which is the most common presentation

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24
Q

What does T2a mean in localised prostate cancer by digital rectal exam

A

less than 50% on one lobe of the prostate

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25
Q

What does T2b mean in localised prostate cancer by digital rectal exam

A

More than 50% on one lobe

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26
Q

What does T2c mean in localised prostate cancer by digital rectal exam

A

More than 50% on both lobes

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27
Q

What does T3 mean in localised prostate cancer by digital rectal exam

A

tumour has moved out of the prostate gland

28
Q

What does T4 mean in localised prostate cancer by digital rectal exam

A

the prostate tumour has spread to the rectum or bladder

29
Q

Describe localised prostate cancer using PSA and TNM

A

T1-2 and a PSA<20

30
Q

Describe locally advanced prostate cancer using PSA and TNM

A

T3-4 and PSA 20-100

31
Q

Describe metastatic prostate cancer using PSA and TNM

A

T and N or T,N and M - PSA >100

32
Q

Describe castrate-resistant prostate cancer using PSA and TNM

A

Any TNM but usually metastatic or locally advanced - PSA rising in spite of hormone therapy

33
Q

Describe Describe D’amico classification for low risk localised

A

PSA less than 10, gleason score of 6 and T stage 1-2a (2a - less than 50% of one lobe) - high recurrence (83%)

34
Q

Describe Describe D’amico classification for Intermeddiate risk localised

A

PSA 10-20
Gleason 7
T stage - T2b (T2b - more than 50% of one lobe) 46% recurrence

35
Q

Describe Describe D’amico classification for high risk localised

A

PSA >20
Gleason>8
T stage - T2c (T2c - more than 50% of both lobes)
29% recurrence

36
Q

Treatment of low risk localised prostate cancer

A

Active surveillance
Surgery - laparascopic, robotic or open
EBRT - external beam radiation therapy
Watchful waiting can also be done

37
Q

What is active surveillance

A

Done if the cancer is caught early and is when you intervene and treat when a change occurs from 6-7 on the Gleason scale

38
Q

Treatment of intermediate risk localised prostate cancer

A

Surgery - EBRT with or without hormone therapy
Watchful waiting can also be done
Give hormone therapy for 2-3 years

39
Q

Treatment of high risk localised prostate cancer

A

EBRT with or without hormone therapy
Watchful waiting can also be done
Give Hormone therapy for 2-3 years

40
Q

Why is watchful waiting done

A

It is done in older patients due to the good prognosis of prostate cancer

41
Q

What are the treatments for localised prostate cancer

A

Watchful waiting
Radiotherapy - external beam (EBRT) or brachytherapy
Radical prostatectomy - open, laparoscopic or robotic

42
Q

What is the treatment of locally advanced prostate cancer

A

watchful waiting
HT - hormone therapy - followed by surgery or radiation or alone

43
Q

What is the affect of decreasing testosterone in the body

A

Will cause the patient to go into remission for many years because it wont cure the prostate cancer but will make the size decrease

44
Q

Types of hormonal therapy

A

Surgical castration
chemical castration - LHRH analogues - down-regulate the androgen receptors but can cause a tumour flare in the first week so anti-androgen is required
Oestrogen can also be used

45
Q

Nme an anti-androgen

A

Bicalutamide and flutamide - inhibit androgen receptors - they are not effective on their own so must be used with LHRH analogues in the case of tumour flare

46
Q

Treatment of metastatic and hormone refractory (castrate-resistant) prostate cancer

A

Immediate hormonal therapy plus chemotherapy in fit patients
Palliative radiotherapy may also be done

47
Q

What is the most common presentation of testicular cancer and what are less common presentations

A

painless lump is most common

Tender inflamed swelling, history of traums and symptoms from distant metastases are less common presentations

48
Q
A
49
Q

What are other causes of lumps in the testes apart from tumours

A

infection causing inflammation- epiddymo-orchitis (inflammation of testicles)
Epididymal cyst
Missed testicular torsion

50
Q

What scan is used for testicular cancer diagnosis

A

Testicular ultrasound

51
Q

When are blood for tumour markers taken in testicular cancer

A

The blood sample is taken at diagnosis for a baseline to compare to the blood sample taken after surgery to make sure the tumour is cleared

52
Q

What are the different types of tumour markers

A

AFP - alpha-fetoprotein
BetaHCG - human chorionic gonadotropin
LDH - lactate dehydrogenase - non specific tumour marker

53
Q

Which lymph nodes do testicular cancers commonly spread to

A

Para-aortic lymph nodes

54
Q

Where is the incision made and why in an inguinal orchidectomy for testicular cancer

A

The incision is at the groin to not disrupt the testes

55
Q

Why is radical orchidectomy essential in testicular cancer treatment (inguinal incision)

A

It is an essential diagnostic procedure as a biopsy is taken and at the same time it is therapeutic as it can cure the patient

56
Q

Why is biopsy of a solid tumour of the testes not done

A

Because the tumour can seedle along the biopsy track

57
Q

What is the most common type of testicular cancer and what is the least common

A

Germ cell tumour (95% of cases)

Non germ cell tumour (5% of cases)

58
Q

What age do serminomatous germ cells tumours normally affect

A

30-40 year olds

59
Q

What age do non-serminomatous germ cells tumours normally affect

A

20-30 year olds

60
Q

How are testicular cancers staged for T,N and M

A

T - pathological assessment of the testicle after orchidectomy
N - CT scan of the para-aortic lymph nodes
M - CT scan of common places for testicular cancer spread - chest, abdomen and pelvis

61
Q

What are the stages of testicular cancer

A

I - disease is localised in the testes

II - spread to the para-aortic lymph nodes but is below the diaphragm

III - spread to the para-aortic lymph nodes but above the diaphragm

IV - Metastasis to solid organs

61
Q

What is always the treatment of testicular cancer

A

Orchidectomy - removal of the testes

61
Q

What is the treatment of low stage testicular cancer after orchidectomy

A

Surveillance , adjuvant radiotherapy or prophylactic chemotherapy

62
Q

What is the treatment of nodal disease testicular cancer

A

Combinational chemotherapy and lymph node dissection

63
Q

What is the treatment for metastatic testicular cancer

A

First line and second line chemotherapy

64
Q

Why is chemotherapy used in seminomas

A

They are radio-resistant

65
Q

What is the prognosis like for testicular cancer

A

Prognosis is good but not as good as prostate cancer prognosis

urinary (24 decks)

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