Prostate CA - urology Flashcards
2 main functions of protate
- fertility - fluid
2. urinary continence
5 major risk factors
- Age
- genetics - father, >3 relatives, BRCA
- race - blacks more, asians less
- diet - high fat
- other - ??vasectomy or T levels - probably not
what is growth of BPH and CA
BPH - transitional and central zone
CA - in peripheral
3 main Sx in advanced
not usually symptomatic
- bone pain
- kidney failure
- anemia
what is use of DRE
alone missed 45% of CA, but still useful with PSA
what is PSA
serum protease involved in liquification of semen
- 60-95% complexed, rest free
DDx for high PSA (5)
- CA
- BPH
- itis
- infarct
- manipulation
what is normal cut-off for PSA
4 - still misses 20% when done alone
5 ways to adjust use of PSA
- age - accept higher number
- race - lower number for blacks
- size of prostate - higher density increases risk (need U/S)
- rate of change >0.75/ yrs is risk
- form - F/Total ratio
what is reccomendation for U/S, MRI and other markers as screeners
not reccomended
what makes a good screen and what is PSA missing
- common disease
- M+M
- effective Tx if caught early
- safe
- cheap
- good spec. and sens. - NOT REALLY
- results in good health outcomes - NOT REALLY
what is controversy with screening
not sure if the NNT is small enough - conflicting studies
what is present guidlines for screening
- 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
how is CA diagnosed
core biopsies
3 ways CA is staged
- DRE and PSA
- gleason grade
- imaging - CT and bone scan
how does gleason grade work
combine the scores of the 2 most common grades of tumor (1-5) for a total of 2-10
what are 3 main levels of gleason
under 5 don’t exist
6 - indolent
7- depends partly on the first number
8-10 - aggressive
what imaging for low, med, adn high risks
low- none
med- CT
high - Ct and bone scan
what are 2 main issues in choosing Tx
- disease related
- stage
- grade
- PSA - patient related
- age
- comorbid
- med and surg. Hx
- QOL prefs
5 main mgmt options
- wathcful waiting
- active surveillance
- rads.
- prostatectomy
- androgen dep. therapy
what is watchful waiting
- no intention of offering Tx with cure
- manage Sx only
what is active surv.
- delay def. Tx, but maintain ability to cure
- need to keep doing monitoring - biopsies, PSA
- many dies with CA, not because of it
what is rads
- brachy and external beam
- need to follow PSA closely
- lower short term morbidity, but maybe more long term
- prostatectomy can be hard after
what is prostatectomy
- definitive Tx with curative intent
- in patient for a 2-3 days
- in-dwelling foley 1-2 weeks
what to do after ectomy
- can add rads or hormone therapy
- PSA more accurate post-op - should be zero
- get final patho- testing
2 main complicaitons
- erection nerve bundle -ED
2. hit the sphincter - stress urinary incontinence
what are clinical benefits of robot
maybe not as amazing as hopes
- less blood
- shorter hospital stay
-
5 things that help determine CA outcome
- stage
- grade
- pre-op PSA
- demographics
- pathology
5 things that help determine functional outcomes
- patient age
- pre-op erectile tuncion
- nerve sparing tech
- PMHx
- surgeon experience
4 main options for mets. disease
- hormone therapy - castrate
- chemo
- rads - esp for bone pain
- novel therapies
