Prostate and Urinary Bladder Cancers Flashcards
How much does a normal prostate in a young adult
Around 20g
Where is the apex of the prostate
Inferior portion of the prostate - continuous with striated sphincter
Where is the base of the prostate
The superior portion and continuous with bladder neck
What is the prostatic urethra covered by
Transitional epithelium
Where is the verumontanum situated
Just distal to the urethral angulation
Where dot he ejaculatory ducts drain to
Each side of the prostatic urethra
What does the transitional zone (TZ) of the prostate surround
The prostatic urethra proximal to the Veru
What does the TZ give rise to
BPH
What does the central zone look like and what does it surround (CZ)
Cone shaped region that surrounds the ejaculatory ducts
Where is the peripheral zone of the prostate (PZ)
Posteriolateral prostate
What makes up the majority of prostatic glandular tissue
Peripheral zone (PZ)
Where do most of the prostate adenocarcinomas originate from
Peripheral zone
What are the peak ages for prostate cancer
70-74years
Where in the world are the incidences of prostate cancer higher
Western world - the highest rates are in Scandinavia and North America
Lowest rates in Asia
What race are more at risk of prostate cancers
Black men
A mutation in what gene is a risk for prostate cancer
BRCA2 gene
What is the typical clinical presentation of a patient with prostate cancer
Gross majoriyt asymptomatic and are picked up by PSA tests and abnormal DRE findings
Some have lower urinary tract symptoms
Haematuria / Haematospermia
Bone pain, anorexia, weight loss
Why can we normally pick up prostate cancer on Rectal examination
75% of prostate cancers arise in the peripheral zone
What are some findings of an abnormal DRE
asymmetry
nodule
fixed craggy mass
What is PSA and where is it produced
A glycoprotein *jallikrein-like serine protease) enzyme produced by the secretory epithelial cells of the prostate gland
What is PSA involved in normally
The liquefaction of semen
in a healthy individual, describe the PSA levels in 1. semen and 2. serum
Semen high
serum low
in an individual with prostate cancer, describe the PSA levels in 1. semen and 2. serum
semen high
Serum high
What are some other conditions which elevate the PSA
BPH Prostatitis / UTIs Retention Catheterisation DRE
What are some indications for testings PSA
Symptomatic patients
In asymptomatic patients counselling for PSA testing prior to testing is mandatory
When is a trans-rectal USS guided prostate biopsy indicated
Men with an abnormal DRE, an elevated PSA
Previous biopsies showing PIN or ASAP
Previous normal biopsies but rising PSA trends
How many biopsies are taken from the prostate in a trans-rectal USS guided prostate biopsy
10
5 form each lobe
What are some complications of a trans-rectal USS guided prostate biopsy
Sepsis
Rectal bleeding
Vaso-vagal fainting
Haematospermia or Haematuria for 2-3 weeks after the procedure
What type of prostate cancers are most common
Multifocal adenomas
Describe the pattern of tumour growth with prostate cancer
Tends to start with local extension through the prostatic capsule to the urethra, bladder base and seminal vesicles and with perineurial invasion along autonomic nerves
Where are the most common sites for metastatic deposits
Pelvic lymph nodes and the skeleton
Describe the characteristic metastatic deposits
Sclerotic
What does the Gleason system give a score based on
The architectural appearance of the prostate glands rather than cytological features
What is the initial feature of malignancy
Loss of the basement membrane
Why is Gleason’s score used widlely
It is a very good predictor of prognosis
What is the staging for prostate cancer
TNM staging
What imaging techniques are useful for helping us to stage prostate cancer
Bone scan
MRI
CT scan
What are some of the considerations to be taken into account before making a decision on the management of prostate cancer
Age co-morbidities life expectancy patient preference quality of life
What are the surgical options for organ confined disease
Radical Prostatectomy- open
Laparoscopic
Robotic
What are some of the complications of radical surgery
Erectile dysfunction
Incontinence
Bladder Neck stenosis
What is the survival rate of prostate cancer treated with radiotherapy with neb-adjuvant hormonal therapy
5 year survival is 79%
When would hormonal therapy be given
To symptomatic patients who need palliation of symptoms
unfit for curative treatment
What are the pharmacological management options for prostate cancer
Hormonal therapy e.g. LHRH analogues, anti-androgens
Diethylstilbesterol / steroids
Cytotoxic chemotherapy
What controls the growth of prostate cancer cells
The influence of testosterone and dihydrotestosterone
What are the two main sources of testosterone
Testis (90%)
Adrenal
What regulates testosterone secretion
Hypothalamic-pituiaty gonadal axis
What does circulating testosterone do in terms of Hypothalamic LH secretion
It exerts a negative feedback control on hypothalamic LH secretion
What happens if prostate cells are deprived of androgenic stimulation
They undergo apoptosis
What does chronic exposure to LHRH result in
down-regulation of LHRH-receptors with subsequent suppression of pituitary LH and FSH secretion and testosterone production
What are some of the side effects of LHRH agonists
Loss of libido hot flushes and sweats weight gain gynaecomastia anaemia cognitive changes osteoporosis
What is meant by the testostersone surge or flare up phenomenon
LHRH analogues initially stimulate pituitary LHRH receptors, inducing a transient rise in LH and FSH release, and consequently elevate testosterone production
To prevent this, anti-androgen is given for cover 1 week before and 2 weeks after the fist dose of LHRH injection
What do anti-androgens compete with for binding sites
Testosterone and DHT
Where are the anti-androgen binding sites
On their receptors in the prostate cell nucleus
What are the two main types of anti-androgen therapies
Steroidal (cyproterone acetate)
and
non-steoridal (nulitamie, flutamide, bicalutamide)
What is an advantage of using Non-steroidal anti-androgens over steroidal anti-androgens
Sexual interest and libido is maintained
What do the majority of uroepithelial tumours arise from
Transitional cell (90%)
What are some of the imaging modalities used for uroepithelial tumours
Excretory urogram sonography retrograde pyelogram CT Angiography
Describe the appearance of transitional cell tumours
They vary
Single lesions - small and papillary to bulky and sessile
Multiple discrete lesions
diffuse and confluent lesions
Describe the appearance of a papillary type uroepithelial tumour
Stippled appearance
What sex is more likely to develop bladder carcinoma
Males
4:1
What is the investigation of choice for urinary bladder cancer
CT urogrpahy
Cystoscopy
