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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
What does T2b mean in localised prostate cancer by digital rectal exam
More than 50% on one lobe
26
What does T2c mean in localised prostate cancer by digital rectal exam
More than 50% on both lobes
27
What does T3 mean in localised prostate cancer by digital rectal exam
tumour has moved out of the prostate gland
28
What does T4 mean in localised prostate cancer by digital rectal exam
the prostate tumour has spread to the rectum or bladder
29
Describe localised prostate cancer using PSA and TNM
T1-2 and a PSA<20
30
Describe locally advanced prostate cancer using PSA and TNM
T3-4 and PSA 20-100
31
Describe metastatic prostate cancer using PSA and TNM
T and N or T,N and M - PSA >100
32
Describe castrate-resistant prostate cancer using PSA and TNM
Any TNM but usually metastatic or locally advanced - PSA rising in spite of hormone therapy
33
Describe Describe D'amico classification for low risk localised
PSA less than 10, gleason score of 6 and T stage 1-2a (2a - less than 50% of one lobe) - high recurrence (83%)
34
Describe Describe D'amico classification for Intermeddiate risk localised
PSA 10-20 Gleason 7 T stage - T2b (T2b - more than 50% of one lobe) 46% recurrence
35
Describe Describe D'amico classification for high risk localised
PSA >20 Gleason>8 T stage - T2c (T2c - more than 50% of both lobes) 29% recurrence
36
Treatment of low risk localised prostate cancer
Active surveillance Surgery - laparascopic, robotic or open EBRT - external beam radiation therapy Watchful waiting can also be done
37
What is active surveillance
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
Treatment of intermediate risk localised prostate cancer
Surgery - EBRT with or without hormone therapy Watchful waiting can also be done Give hormone therapy for 2-3 years
39
Treatment of high risk localised prostate cancer
EBRT with or without hormone therapy Watchful waiting can also be done Give Hormone therapy for 2-3 years
40
Why is watchful waiting done
It is done in older patients due to the good prognosis of prostate cancer
41
What are the treatments for localised prostate cancer
Watchful waiting Radiotherapy - external beam (EBRT) or brachytherapy Radical prostatectomy - open, laparoscopic or robotic
42
What is the treatment of locally advanced prostate cancer
watchful waiting HT - hormone therapy - followed by surgery or radiation or alone
43
What is the affect of decreasing testosterone in the body
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
Types of hormonal therapy
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
Nme an anti-androgen
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
Treatment of metastatic and hormone refractory (castrate-resistant) prostate cancer
Immediate hormonal therapy plus chemotherapy in fit patients Palliative radiotherapy may also be done
47
What is the most common presentation of testicular cancer and what are less common presentations
painless lump is most common Tender inflamed swelling, history of traums and symptoms from distant metastases are less common presentations
48
49
What are other causes of lumps in the testes apart from tumours
infection causing inflammation- epiddymo-orchitis (inflammation of testicles) Epididymal cyst Missed testicular torsion
50
What scan is used for testicular cancer diagnosis
Testicular ultrasound
51
When are blood for tumour markers taken in testicular cancer
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
What are the different types of tumour markers
AFP - alpha-fetoprotein BetaHCG - human chorionic gonadotropin LDH - lactate dehydrogenase - non specific tumour marker
53
Which lymph nodes do testicular cancers commonly spread to
Para-aortic lymph nodes
54
Where is the incision made and why in an inguinal orchidectomy for testicular cancer
The incision is at the groin to not disrupt the testes
55
Why is radical orchidectomy essential in testicular cancer treatment (inguinal incision)
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
Why is biopsy of a solid tumour of the testes not done
Because the tumour can seedle along the biopsy track
57
What is the most common type of testicular cancer and what is the least common
Germ cell tumour (95% of cases) Non germ cell tumour (5% of cases)
58
What age do serminomatous germ cells tumours normally affect
30-40 year olds
59
What age do non-serminomatous germ cells tumours normally affect
20-30 year olds
60
How are testicular cancers staged for T,N and M
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
What are the stages of testicular cancer
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
What is always the treatment of testicular cancer
Orchidectomy - removal of the testes
61
What is the treatment of low stage testicular cancer after orchidectomy
Surveillance , adjuvant radiotherapy or prophylactic chemotherapy
62
What is the treatment of nodal disease testicular cancer
Combinational chemotherapy and lymph node dissection
63
What is the treatment for metastatic testicular cancer
First line and second line chemotherapy
64
Why is chemotherapy used in seminomas
They are radio-resistant
65
What is the prognosis like for testicular cancer
Prognosis is good but not as good as prostate cancer prognosis

urinary (24 decks)

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