Prostate and Urinary Bladder Cancers Flashcards
What are the part of the prostate?
Apex
Base
Prostatic urethra
What is the verumontanum?
It is the areas where the ejaculatory ducts open into.
if it is closed the semen doesnt flow
60 y/o polyuria, and peeing at night. Which area of the prostate affected?
Enlargement of the transition zone as it wraps around the urethra - gives rise to BPH
65 y/o man urinary symptoms differential
Prostate enlargement (BPH)
Cancer (rare as it arises from the peripheral zone)
Transition zone
mesoderm
Peripheral zone
endoderm
What are the 3 zones of the prostate?
Transitional, central, peripheral
What is the most common malignancy affecting men in the UK?
Prostate cancer
What is the mortality for prostate?
2nd highest cancer mortality
Is the incidence or mortality of prostate cancer more?
Incidence is higher
Is PSA prostate-specific or prostate-cancer specific antigen?
Prostate specific antigen –> cancer or infection can cause it. Hence marker of prostate disease
Where is prostate cancer more common in the world?
Western world
What is the most common symptom in prostate cancer?
BPH - from transitional zone
cancer - peripheral zone
Asymptomatic
- Picked up by PSA and DRE findings
- Hard prostate
- urinary symptoms –> quite later on
- bone pain, anorexia, weight loss
What increases the risk of prostate cancer?
family
westen lifestyle
What do you find in DRE?
- Asymmetry
- Nodule
- Fixed craggy mass
What is the main function of PSA?
GLycoprotein produced by the secretory epithelial cells of the prostate gland
Liquefaction of semen
What would raised PSA signify?
US, combined with 10 biopsy samples (5 from each prostate) and DRE
What are the PSA findings in a healthy individual?
high semen PSA levels and low seum PSA levels
Why do you take 10 samples in prostate biopsy?
As prostate cancers are multifocal adenocarcinomas
What are the common sites for metastatic deposits in prostate cancer?
pelvic lymph nodes and the skeleton
sclerotic lesions are characteristic
What is the scoring system for prostate cancer?
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
Stage prostatic cancer
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
What are the imaging modalities for prostate cancer staging?
Bone scan
MRI
CT scan
T1-2 N0 M0
Organ-confined disease
T3-4 N0 M0
locally advanced disease
N+, M+
Metastatic disease
gleason 6, and the person is quite old and more likely to die with another disease
Let it be
Intermediate risk and high risk
Radical prostatectomy - open/ laparectomy/ prostate
Radical radiotherapy - external beam RT< pr brachytherapy - put something inside
Locally advanced disease treatment
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)
Side effects of androgen deprivation therapy:
depression/ cognitive impairement
gynaecomastia
Where does the steroid act on for androgen deprivation therapy?
Block testosterone at the receptor level
mucosal staging of bladder cancer
PT, then PT1, PT
How does blaadder cancer present?
Painless Haematuria (95%) -elderly patient >45 y/o should be investigated
What are the investigations for bladder cancer?
Flexible cystoscopy CT scan (if allergic to contrast --> MRI)
What is the most common urinary bladder?
Transitional cancer
What are the two tupes of transitional cell carcinoma?
Papillary and Non-Papillary cancer
How serious are papillary type of cancer?
no that scary, 50% infiltrative malignancies
How serious are non-papillary type of cancer?
all are malignant
What is the gross appeatance on imaging studies?
mutlifocal lesions vs single lesions
most common- non-invasive lesions
