Prostate and Urinary Bladder Cancers

Question 1

What are the part of the prostate?

Answer 1

Apex
Base
Prostatic urethra

Question 2

What is the verumontanum?

Answer 2

It is the areas where the ejaculatory ducts open into.

if it is closed the semen doesnt flow

Question 3

60 y/o polyuria, and peeing at night. Which area of the prostate affected?

Answer 3

Enlargement of the transition zone as it wraps around the urethra - gives rise to BPH

Question 4

65 y/o man urinary symptoms differential

Answer 4

Prostate enlargement (BPH)

Cancer (rare as it arises from the peripheral zone)

Question 5

Transition zone

Answer 5

mesoderm

Question 6

Peripheral zone

Answer 6

endoderm

Question 7

What are the 3 zones of the prostate?

Answer 7

Transitional, central, peripheral

Question 8

What is the most common malignancy affecting men in the UK?

Answer 8

Prostate cancer

Question 9

What is the mortality for prostate?

Answer 9

2nd highest cancer mortality

Question 10

Is the incidence or mortality of prostate cancer more?

Answer 10

Incidence is higher

Question 11

Is PSA prostate-specific or prostate-cancer specific antigen?

Answer 11

Prostate specific antigen –> cancer or infection can cause it. Hence marker of prostate disease

Question 12

Where is prostate cancer more common in the world?

Answer 12

Western world

Question 13

What is the most common symptom in prostate cancer?

Answer 13

BPH - from transitional zone
cancer - peripheral zone

Asymptomatic

1. Picked up by PSA and DRE findings
2. Hard prostate
3. urinary symptoms –> quite later on
4. bone pain, anorexia, weight loss

Question 14

What increases the risk of prostate cancer?

Answer 14

family

westen lifestyle

Question 15

What do you find in DRE?

Answer 15

• Asymmetry
  
  • Nodule
  • Fixed craggy mass

Question 16

What is the main function of PSA?

Answer 16

GLycoprotein produced by the secretory epithelial cells of the prostate gland

Liquefaction of semen

Question 17

What would raised PSA signify?

Answer 17

US, combined with 10 biopsy samples (5 from each prostate) and DRE

Question 18

What are the PSA findings in a healthy individual?

Answer 18

high semen PSA levels and low seum PSA levels

Question 19

Why do you take 10 samples in prostate biopsy?

Answer 19

As prostate cancers are multifocal adenocarcinomas

Question 20

What are the common sites for metastatic deposits in prostate cancer?

Answer 20

pelvic lymph nodes and the skeleton

sclerotic lesions are characteristic

Question 21

What is the scoring system for prostate cancer?

Answer 21

Gleason’s scoring

Take the most fequent appearance 1st(eg: 3), then the 2nd frequent one

score range - 2-10

4-6 low risk
7-8 moderate
>8 - severe

4+4 = 8

Question 22

Stage prostatic cancer

Answer 22

T-Primary Tumour

T1 Clinically in-apparent tumour not palpable or visible by imaging

T2 Tumour confined within the prostate

T3 Tumour extends through the prostatic capsule

T4 Tumour fixed or invades adjacent structures other than seminal vesicles: bladder neck, external sphincter, rectum, levator muscles or pelvic wall

Question 23

What are the imaging modalities for prostate cancer staging?

Answer 23

Bone scan
MRI
CT scan

Question 24

T1-2 N0 M0

Answer 24

Organ-confined disease

Question 25

T3-4 N0 M0

Answer 25

locally advanced disease

Question 26

N+, M+

Answer 26

Metastatic disease

Question 27

gleason 6, and the person is quite old and more likely to die with another disease

Answer 27

Let it be

Question 28

Intermediate risk and high risk

Answer 28

Radical prostatectomy - open/ laparectomy/ prostate Radical radiotherapy - external beam RT< pr brachytherapy - put something inside

Question 29

Locally advanced disease treatment

Answer 29

Hormonal therapy - symptomatic patients, who need palliation of symptoms, stop testosterone, shrink the tumour blocks the testosterone effects on the cancer cells (reduce the LH/ FSH secretion)

Question 30

Side effects of androgen deprivation therapy:

Answer 30

depression/ cognitive impairement | gynaecomastia

Question 31

Where does the steroid act on for androgen deprivation therapy?

Answer 31

Block testosterone at the receptor level

Question 32

mucosal staging of bladder cancer

Answer 32

PT, then PT1, PT

Question 33

How does blaadder cancer present?

Answer 33

``` Painless Haematuria (95%) -elderly patient >45 y/o should be investigated ```

Question 34

What are the investigations for bladder cancer?

Answer 34

``` Flexible cystoscopy CT scan (if allergic to contrast --> MRI) ```

Question 35

What is the most common urinary bladder?

Answer 35

Transitional cancer

Question 36

What are the two tupes of transitional cell carcinoma?

Answer 36

Papillary and Non-Papillary cancer

Question 37

How serious are papillary type of cancer?

Answer 37

no that scary, 50% infiltrative malignancies

Question 38

How serious are non-papillary type of cancer?

Answer 38

all are malignant

Question 39

What is the gross appeatance on imaging studies?

Answer 39

mutlifocal lesions vs single lesions most common- non-invasive lesions