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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
Q

What are some indications for testings PSA

A

Symptomatic patients

In asymptomatic patients counselling for PSA testing prior to testing is mandatory

26
Q

When is a trans-rectal USS guided prostate biopsy indicated

A

Men with an abnormal DRE, an elevated PSA
Previous biopsies showing PIN or ASAP
Previous normal biopsies but rising PSA trends

27
Q

How many biopsies are taken from the prostate in a trans-rectal USS guided prostate biopsy

A

10

5 form each lobe

28
Q

What are some complications of a trans-rectal USS guided prostate biopsy

A

Sepsis
Rectal bleeding
Vaso-vagal fainting
Haematospermia or Haematuria for 2-3 weeks after the procedure

29
Q

What type of prostate cancers are most common

A

Multifocal adenomas

30
Q

Describe the pattern of tumour growth with prostate cancer

A

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
Q

Where are the most common sites for metastatic deposits

A

Pelvic lymph nodes and the skeleton

32
Q

Describe the characteristic metastatic deposits

A

Sclerotic

33
Q

What does the Gleason system give a score based on

A

The architectural appearance of the prostate glands rather than cytological features

34
Q

What is the initial feature of malignancy

A

Loss of the basement membrane

35
Q

Why is Gleason’s score used widlely

A

It is a very good predictor of prognosis

36
Q

What is the staging for prostate cancer

A

TNM staging

37
Q

What imaging techniques are useful for helping us to stage prostate cancer

A

Bone scan
MRI
CT scan

38
Q

What are some of the considerations to be taken into account before making a decision on the management of prostate cancer

A 
Age 
co-morbidities
life expectancy 
patient preference 
quality of life
39
Q

What are the surgical options for organ confined disease

A

Radical Prostatectomy- open
Laparoscopic
Robotic

40
Q

What are some of the complications of radical surgery

A

Erectile dysfunction
Incontinence
Bladder Neck stenosis

41
Q

What is the survival rate of prostate cancer treated with radiotherapy with neb-adjuvant hormonal therapy

A

5 year survival is 79%

42
Q

When would hormonal therapy be given

A

To symptomatic patients who need palliation of symptoms

unfit for curative treatment

43
Q

What are the pharmacological management options for prostate cancer

A

Hormonal therapy e.g. LHRH analogues, anti-androgens
Diethylstilbesterol / steroids
Cytotoxic chemotherapy

44
Q

What controls the growth of prostate cancer cells

A

The influence of testosterone and dihydrotestosterone

45
Q

What are the two main sources of testosterone

A

Testis (90%)

Adrenal

46
Q

What regulates testosterone secretion

A

Hypothalamic-pituiaty gonadal axis

47
Q

What does circulating testosterone do in terms of Hypothalamic LH secretion

A

It exerts a negative feedback control on hypothalamic LH secretion

48
Q

What happens if prostate cells are deprived of androgenic stimulation

A

They undergo apoptosis

49
Q

What does chronic exposure to LHRH result in

A

down-regulation of LHRH-receptors with subsequent suppression of pituitary LH and FSH secretion and testosterone production

50
Q

What are some of the side effects of LHRH agonists

A 
Loss of libido 
hot flushes and sweats 
weight gain
gynaecomastia 
anaemia 
cognitive changes 
osteoporosis
51
Q

What is meant by the testostersone surge or flare up phenomenon

A

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
Q

What do anti-androgens compete with for binding sites

A

Testosterone and DHT

53
Q

Where are the anti-androgen binding sites

A

On their receptors in the prostate cell nucleus

54
Q

What are the two main types of anti-androgen therapies

A

Steroidal (cyproterone acetate)
and
non-steoridal (nulitamie, flutamide, bicalutamide)

55
Q

What is an advantage of using Non-steroidal anti-androgens over steroidal anti-androgens

A

Sexual interest and libido is maintained

56
Q

What do the majority of uroepithelial tumours arise from

A

Transitional cell (90%)

57
Q

What are some of the imaging modalities used for uroepithelial tumours

A 
Excretory urogram 
sonography 
retrograde pyelogram 
CT 
Angiography
58
Q

Describe the appearance of transitional cell tumours

A

They vary
Single lesions - small and papillary to bulky and sessile
Multiple discrete lesions
diffuse and confluent lesions

59
Q

Describe the appearance of a papillary type uroepithelial tumour

A

Stippled appearance

60
Q

What sex is more likely to develop bladder carcinoma

A

Males

4:1

61
Q

What is the investigation of choice for urinary bladder cancer

A

CT urogrpahy

Cystoscopy

SM Renal (23 decks)

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