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SM Renal > Prostate and Urinary Bladder Cancers > Flashcards

Prostate and Urinary Bladder Cancers Flashcards

1
Q

How much does a normal prostate in a young adult

A

Around 20g

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2
Q

Where is the apex of the prostate

A

Inferior portion of the prostate - continuous with striated sphincter

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3
Q

Where is the base of the prostate

A

The superior portion and continuous with bladder neck

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4
Q

What is the prostatic urethra covered by

A

Transitional epithelium

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5
Q

Where is the verumontanum situated

A

Just distal to the urethral angulation

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6
Q

Where dot he ejaculatory ducts drain to

A

Each side of the prostatic urethra

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7
Q

What does the transitional zone (TZ) of the prostate surround

A

The prostatic urethra proximal to the Veru

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8
Q

What does the TZ give rise to

A

BPH

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9
Q

What does the central zone look like and what does it surround (CZ)

A

Cone shaped region that surrounds the ejaculatory ducts

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10
Q

Where is the peripheral zone of the prostate (PZ)

A

Posteriolateral prostate

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11
Q

What makes up the majority of prostatic glandular tissue

A

Peripheral zone (PZ)

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12
Q

Where do most of the prostate adenocarcinomas originate from

A

Peripheral zone

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13
Q

What are the peak ages for prostate cancer

A

70-74years

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14
Q

Where in the world are the incidences of prostate cancer higher

A

Western world - the highest rates are in Scandinavia and North America
Lowest rates in Asia

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15
Q

What race are more at risk of prostate cancers

A

Black men

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16
Q

A mutation in what gene is a risk for prostate cancer

A

BRCA2 gene

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17
Q

What is the typical clinical presentation of a patient with prostate cancer

A

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

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18
Q

Why can we normally pick up prostate cancer on Rectal examination

A

75% of prostate cancers arise in the peripheral zone

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19
Q

What are some findings of an abnormal DRE

A

asymmetry
nodule
fixed craggy mass

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20
Q

What is PSA and where is it produced

A

A glycoprotein *jallikrein-like serine protease) enzyme produced by the secretory epithelial cells of the prostate gland

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21
Q

What is PSA involved in normally

A

The liquefaction of semen

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22
Q

in a healthy individual, describe the PSA levels in 1. semen and 2. serum

A

Semen high

serum low

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23
Q

in an individual with prostate cancer, describe the PSA levels in 1. semen and 2. serum

A

semen high

Serum high

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24
Q

What are some other conditions which elevate the PSA

A 
BPH 
Prostatitis / UTIs
Retention
Catheterisation 
DRE
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25
What are some indications for testings PSA
Symptomatic patients | In asymptomatic patients counselling for PSA testing prior to testing is mandatory
26
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
27
How many biopsies are taken from the prostate in a trans-rectal USS guided prostate biopsy
10 | 5 form each lobe
28
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
29
What type of prostate cancers are most common
Multifocal adenomas
30
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
31
Where are the most common sites for metastatic deposits
Pelvic lymph nodes and the skeleton
32
Describe the characteristic metastatic deposits
Sclerotic
33
What does the Gleason system give a score based on
The architectural appearance of the prostate glands rather than cytological features
34
What is the initial feature of malignancy
Loss of the basement membrane
35
Why is Gleason's score used widlely
It is a very good predictor of prognosis
36
What is the staging for prostate cancer
TNM staging
37
What imaging techniques are useful for helping us to stage prostate cancer
Bone scan MRI CT scan
38
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 ```
39
What are the surgical options for organ confined disease
Radical Prostatectomy- open Laparoscopic Robotic
40
What are some of the complications of radical surgery
Erectile dysfunction Incontinence Bladder Neck stenosis
41
What is the survival rate of prostate cancer treated with radiotherapy with neb-adjuvant hormonal therapy
5 year survival is 79%
42
When would hormonal therapy be given
To symptomatic patients who need palliation of symptoms | unfit for curative treatment
43
What are the pharmacological management options for prostate cancer
Hormonal therapy e.g. LHRH analogues, anti-androgens Diethylstilbesterol / steroids Cytotoxic chemotherapy
44
What controls the growth of prostate cancer cells
The influence of testosterone and dihydrotestosterone
45
What are the two main sources of testosterone
Testis (90%) | Adrenal
46
What regulates testosterone secretion
Hypothalamic-pituiaty gonadal axis
47
What does circulating testosterone do in terms of Hypothalamic LH secretion
It exerts a negative feedback control on hypothalamic LH secretion
48
What happens if prostate cells are deprived of androgenic stimulation
They undergo apoptosis
49
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
50
What are some of the side effects of LHRH agonists
``` Loss of libido hot flushes and sweats weight gain gynaecomastia anaemia cognitive changes osteoporosis ```
51
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
52
What do anti-androgens compete with for binding sites
Testosterone and DHT
53
Where are the anti-androgen binding sites
On their receptors in the prostate cell nucleus
54
What are the two main types of anti-androgen therapies
Steroidal (cyproterone acetate) and non-steoridal (nulitamie, flutamide, bicalutamide)
55
What is an advantage of using Non-steroidal anti-androgens over steroidal anti-androgens
Sexual interest and libido is maintained
56
What do the majority of uroepithelial tumours arise from
Transitional cell (90%)
57
What are some of the imaging modalities used for uroepithelial tumours
``` Excretory urogram sonography retrograde pyelogram CT Angiography ```
58
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
59
Describe the appearance of a papillary type uroepithelial tumour
Stippled appearance
60
What sex is more likely to develop bladder carcinoma
Males | 4:1
61
What is the investigation of choice for urinary bladder cancer
CT urogrpahy | Cystoscopy

SM Renal (23 decks)

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