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Undeleted > Prostate CA - urology > Flashcards

Prostate CA - urology Flashcards

1
Q

2 main functions of protate

A
  1. fertility - fluid

2. urinary continence

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2
Q

5 major risk factors

A
  1. Age
  2. genetics - father, >3 relatives, BRCA
  3. race - blacks more, asians less
  4. diet - high fat
  5. other - ??vasectomy or T levels - probably not
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3
Q

what is growth of BPH and CA

A

BPH - transitional and central zone

CA - in peripheral

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4
Q

3 main Sx in advanced

A

not usually symptomatic

  1. bone pain
  2. kidney failure
  3. anemia
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5
Q

what is use of DRE

A

alone missed 45% of CA, but still useful with PSA

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6
Q

what is PSA

A

serum protease involved in liquification of semen

- 60-95% complexed, rest free

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7
Q

DDx for high PSA (5)

A
  1. CA
  2. BPH
  3. itis
  4. infarct
  5. manipulation
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8
Q

what is normal cut-off for PSA

A

4 - still misses 20% when done alone

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9
Q

5 ways to adjust use of PSA

A
  1. age - accept higher number
  2. race - lower number for blacks
  3. size of prostate - higher density increases risk (need U/S)
  4. rate of change >0.75/ yrs is risk
  5. form - F/Total ratio
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10
Q

what is reccomendation for U/S, MRI and other markers as screeners

A

not reccomended

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11
Q

what makes a good screen and what is PSA missing

A
  1. common disease
  2. M+M
  3. effective Tx if caught early
  4. safe
  5. cheap
  6. good spec. and sens. - NOT REALLY
  7. results in good health outcomes - NOT REALLY
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12
Q

what is controversy with screening

A

not sure if the NNT is small enough - conflicting studies

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13
Q

what is present guidlines for screening

A
  • discuss risks and benefits
  • inconclusive benefit for mass screening
  • none for over 75
  • annual DRE/PSA offered at 50, or 40 if high risk
  • baseline PSA at 40-49
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14
Q

how is CA diagnosed

A

core biopsies

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15
Q

3 ways CA is staged

A
  1. DRE and PSA
  2. gleason grade
  3. imaging - CT and bone scan
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16
Q

how does gleason grade work

A

combine the scores of the 2 most common grades of tumor (1-5) for a total of 2-10

17
Q

what are 3 main levels of gleason

A

under 5 don’t exist
6 - indolent
7- depends partly on the first number
8-10 - aggressive

18
Q

what imaging for low, med, adn high risks

A

low- none
med- CT
high - Ct and bone scan

19
Q

what are 2 main issues in choosing Tx

A
  1. disease related
    - stage
    - grade
    - PSA
  2. patient related
    - age
    - comorbid
    - med and surg. Hx
    - QOL prefs
20
Q

5 main mgmt options

A
  1. wathcful waiting
  2. active surveillance
  3. rads.
  4. prostatectomy
  5. androgen dep. therapy
21
Q

what is watchful waiting

A
  • no intention of offering Tx with cure

- manage Sx only

22
Q

what is active surv.

A
  • delay def. Tx, but maintain ability to cure
  • need to keep doing monitoring - biopsies, PSA
  • many dies with CA, not because of it
23
Q

what is rads

A
  • brachy and external beam
  • need to follow PSA closely
  • lower short term morbidity, but maybe more long term
  • prostatectomy can be hard after
24
Q

what is prostatectomy

A
  • definitive Tx with curative intent
  • in patient for a 2-3 days
  • in-dwelling foley 1-2 weeks
25
Q

what to do after ectomy

A
  • can add rads or hormone therapy
  • PSA more accurate post-op - should be zero
  • get final patho- testing
26
Q

2 main complicaitons

A
  1. erection nerve bundle -ED

2. hit the sphincter - stress urinary incontinence

27
Q

what are clinical benefits of robot

A

maybe not as amazing as hopes
- less blood
- shorter hospital stay
-

28
Q

5 things that help determine CA outcome

A
  1. stage
  2. grade
  3. pre-op PSA
  4. demographics
  5. pathology
29
Q

5 things that help determine functional outcomes

A
  1. patient age
  2. pre-op erectile tuncion
  3. nerve sparing tech
  4. PMHx
  5. surgeon experience
30
Q

4 main options for mets. disease

A
  1. hormone therapy - castrate
  2. chemo
  3. rads - esp for bone pain
  4. novel therapies

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