Prostate & Bladder Cancer Flashcards
Where is the base of the prostate located?
Next to the bladder
Where is the apex of the bladder located?
Inferior part of prostate
continuous with striated sphincter
What type of epithelium covers the prostatic urethra
transitional epithelium
What are the 3 main zones of the prostate?
Transitional zone
Central zone
Peripheral zone
In what zone do most adenocarcinomas of the prostate occur?
Peripheral zone
Which zone of the prostate is responsible for BPH?
Transitional
Many patients may die from other causes rather than causes directly attributable to prostate cancer. TRUE/FALSE?
TRUE
other comorbidities usually are responsible for the death rather than the cancer
When is the peak incidence of prostatic cancer?
Peak age-70-74 years
The majority of prostate cancers are asymptomatic. TRUE/FALSE?
TRUE
Picked up by PSA tests and abnormal DRE findings
If patients with prostatic cancer do present with symptoms, what do they commonly present with?
- Lower urinary tract symptoms
- Haematuria
- Bone pain, Anorexia, Weight loss
What features indicate an abnormal finding on a Digital Rectal Examination?
- Asymmetry
- Nodule
- Fixed craggy mass
Prostate specific antigen has a high specificity for prostate cancer. TRUE/FALSE?
FALSE Many other things can cause raised PSA BPH Prostatitis / UTI’s Retention Catheter DRE
An abnormal DRE and elevated PSA indicates what type of biopsy must be carried out?
Trans-Rectal Ultrasound guided Prostate Biopsy
How many biopsies are taken during a trans-rectal US prostate biopsy and why?
10 biopsies taken
( 5 from each lobe )
Many prostate cancers are multifocal => in multiple places on the prostate
What do trans-rectal US prostate biopsies carry a sepsis risk?
Potential to take bacteria from rectum through the wall to the prostate
Describe the normal pattern of local tumour growth in prostate cancer?
prostatic capsule urethra bladder base seminal vesicals Perineural invasion along autonomic nerves
How are prostate cancers graded?
Gleason’s Scoring
Microscopically graded from 1 to 5
Two most abundant cell patterns are assessed then added together to give a score between 2 to 10
What are the 3 broad classifications of prostate cancer?
Organ-Confined disease
T1-2 N0 M0
Locally advanced Disease
T3-4 N0 M0
Metastatic Disease
N+, M+
How is organ confined prostate cancer usually treated?
Watchful waiting
Active surveillance
Radical surgery
Radical radiotherapy
How is locally advanced disease normally treated?
Radiotherapy with neo-adjuvant hormonal therapy
If not suitable for curative Tx, they can be given hormonal therapy on its own to help symptoms
How is metastatic prostate cancer usually treated?
Androgen Deprivation therapy
Diethylstilbesterol (oestrogen)
Steroids
Cytotoxic chemotherapy
What hormones are known to stimulate the growth of prostatic cancer cells?
testosterone and dihydrotestosterone
How can we ensure prostate cells undergo apoptosis?
Deprive them of androgenic stimulation
What is the aim of LNRH agonists?
eventually down-regulates LHRH-receptors
=> suppress LH and FSH secretion and testosterone production
Why should you cover 1 week before and 2 weeks after the first dose of LHRH injection with an anti-androgen?
In this time the LNRH can cause a small rise in FSH,LH and testosterone
=> having a negative effect
What is the function of anti-androgens?
Compete with testosterone and DHT
- binding site = on receptors in prostate cell nucleus
=> apoptosis and inhibiting cancer growth
What are the two types of anti-androgens?
Steroidal (cyproterone acetate)
Non-steroidal (nilutamide, flutamide and bicalutamide)
Most bladder cancers arise from what type of epithelium?
Transitional/urothelium (90%)
Squamous (9%)
What are the two main types of transitional epithelium cancer?
Papillary (around 50% malignant)
Non-papillary (All considered malignant)
How can transitional epithelium tumours be imaged?
Excretory urogram Sonography Retrograde pyelogram CT Angiography
What is a bladder halo sign?
A filling defect associated with bladder cancer which is highlighted by contrast
What is the first procedural investigation you would use for bladder cancer?
Cystoscopy
