Prostate and Urinary Cancer Flashcards
where is the prostate located
base of bladder and circles the urethra
what is the function of the prostate
adds lubricant and fluid to sperm
what are the 3 zones of the prostate
transitional, central, peripheral
what age group does prostate cancer commonly affect
age 70-75 (is rare under 50)
what is a random risk factor for prostate cancer
cadmium batteries
what is a common presentation of prostate cancer
lower UTI symptoms, haematuria, haematospermia, bone pain, anorexia, weight loss
what investigations are done for prostate cancer
PSA test (high serum), PR, trans-rectal USS
what are abnormal findings from a PR prostate exam
asymmetry, nodules, fixed mass
what conditions beside prostate cancer may show an elevated PSA
benign prostate hyperplasia, prostatitis, retention, catheterisation
what is the most common type of prostate adenocarcinoma
95% multifocal
where do prostate adenocarcinomas locally extend to
through capsule –> urethra –> bladder –> seminal vesicles –> autonomic nerves
where does prostatic cancer commonly metastasise to
pelvic lymph nodes and skeleton (sclerotic legions)
what scale is used for grading prostate cancer
gleason’s: 1-5 (5 worst prognosis)
what investigations are done for staging of prostate cancer
bone scan, MRI, CT
what management is done for a confined prostate cancer
radiotherapy and surgery if needed
what management is done for metastases of prostate cancer
androgen deprivation (hormonal, orchidectomy), steroids, chemo
what hormones cause proliferation of prostate cells
testosterone/ dihydrotestosterone
what drugs reduce testosterone
LH receptor hormone analogue Aka GnRH agonists (and anti-androgens)
how do LHRH agonists work to reduce testosterone
cause transient rise in LH, FSH and testosterone but negative feedback then down-regulates and reduces production
what do LHRH agonists need to be covered with in first 1-2 weeks
anti-androgens
how do anti-androgens work
compete with testosterone and DHT on prostate cells
name a steroidal anti-androgen and the side effects they cause
cyproterone acetate - loss of libido and erectile dysfunction
name a non-steroidal anti-androgen and the side effects they cause
nilutamide, fultamide, bicalutamide - gynaecomastia, breast pain, hepatotoxity (libido remains)
what are common side effects of hormonal treatment to prostate cancer
loss of libido, hot flushes, weight gain, gynaecomastia, anaemia, osteoporosis
which age group is commonly affected by BPH
affects 75% of men over 70
what usually causes BPH
imbalance of hormones - decreases androgens and normal oestrogen
what are symptoms of BPH
prostatism: poor stream, overflow incontinence, can’t start peeing, dribbling
what are treatment options for BPH
1st line alpha blocker eg tamsulosin / 5a reductase inhibitor / surgery
what are the main types of urinary tumours
transitional (90%), squamous (9%), 1% adenocarcinomas and sarcomas
what are risk factors for urinary cancer
males and smoking (almost as big a risk factor as it is for lung cancer)
what is the most common type of transitional urinary tumour and is it malignant
80% are papillary type and of those 50% are malignant (carcinoma or papilloma)
what is the 2nd most common type of transitional urinary tumour and is it malignant
non-papillary (20%) and they are all malignant
what is seen on a transitional cell urinary biopsy
multi-centric, striated, multiple discrete legions
what increases risk of developing transitional cell carcinoma of the bladder
catheter
what is urachal adenocarcinoma
remnant of allantois (connected umbilicus to bladder in embryo)
how can SSC’s develop in the bladder
persistant inflam –> squamous metaplasia
