Prostate cancer and bladder cancer Flashcards
Leading causes of cancer death in men
1) Lung
2) Prostate
3) Colorectal
4) Pancreatic
5) Leukemia
Prostate cancer
Most common cancer in men and second leading cause of cancer death in men.
Risk factors are advanced age and positive family history
History and exam for prostate cancer
1) Usually ASx, but may present with obstructive urinary symptoms (retention, low force of urine stream) as well as with lymphedema due to obstructing mets, constitutional symptoms, and back pain due to bone mets
2) DRE may reveal a palpable nodule or an area of induration. Early carcinoma is usually not detectable on exam
3) A tender prostate suggests prostatitis
Dx of prostate cancer
1) Suggested by clinical findings and/or markedly elevated PSA (above 4)
2) Definitive dx is made with US guided transrectal bx, which typically shows adenocarcinoma
3) Tumors graded by Gleason system, which sums scores (1-5) of 2 most dysplastic samples
4) Look for mets with CXR and bone scan (met lesions show an osteoblastic or increased bone density). Fully 40% of patients present with mets at diagnosis
Remember: high PSA can be from cancer, BPH, prostatitis, UTI or prostate trauma
Tx of prostate cancer
1) Tx is controversial, as many cases of prostate cancer are slow to progress. Tx choice is based on the aggressiveness of the tumor and the patient’s mortality risk.
2) Watchful waiting may be the best approach for elderly patients with low-grade tumors
3) Radical prosatectomy and radiation (brachytherapy or external beam) are associated with an increased risk of incontinence and/or impotence.
4) PSA, while controversial as a screening tool, is used to follow patients post treatment to evaluate for disease recurrence.
5) Treat metastatic disease with androgen ablation (GnRH agonists, orchiectomy, flutamide) and chemo
Prevention of prostate cancer
1) All males over 50 should have annual DRE. Screening should begin earlier in african american males and in those with first degree relative with prostate cancer
2) Screening with PSA is common, but its utility remains controversial
Ddx for hematuria
I PEE RBCS
1) Infection (UTI)
2) PKD
3) Exercise
4) External trauma
5) Renal glomerular disease
6) BPH
7) Cancer
8) Stones
Bladder cancer
Second most common urologic cancer and the most frequent malignant tumor of the urinary tract.
Usually a transitional cell carcinoma
Most prevalent in males during 6th and 7th decades
Risk factors: smoking, diets rich in meat and fat, schistosomiasis, chronic treatment with cyclophosphamide and occupational exposure to aniline dye
history and exam for bladder cancer
1) Gross hematuria* is most common presenting symptom
2) Other urinary symptoms, such as frequency, urgency, and dysuria may also be seen. Most patients are ASx in early stages tho
Dx of bladder cancer
1) Cystoscopy with bx is diagnostic and is recommended in the evaluation of older adults to rule out malignancy
2) UA often shows hematuria (macro or micro)
3) Cytology may show dysplastic cells
4) MRI, CT and bone scan are important tools to define invasion and mets
5) IVP can examine the upper urinary tract as well as defects in bladder filling. Seldom used.
Tx of bladder cancer
Treatment depends on extent of spread beyond bladder mucosa
1) Carcinoma in situ - intravesicular chemo
2) Superficial cancers - complete transurehtral resection or intravesicular chemo with mitomycinC or BCG (the TB vaccine)
3) Large, high grade recurrent lesions - intravesicular chemo
4) Invasive cancers without mets - Radical cystectomy or radiotherapy for patients who are deemed poor candidates for radical cystectomy as well as for those with unresectable local diseaes
5) Mets - chemo alone
