Prostate Cancer, Varicocele, Testicular tumors Flashcards
PSA density
serum PSA concentration divided by prostate volume
> .15 may be significant
-Helpful in differentiating cancer from BPH
Symptoms of metastasis
- bone pain
- weight loss
- anemia
- azotemia
- fatigue
- dyspnea
- Lymphedema
- Ureteral obstruction
Adverse effects of radical prostatectomy
- impotence
- bladder neck contractures
- incontinence
Name 3 hormonal manipulation therapies
- Bilateral orchiectomy
- LH-RH analogs (Leuprolide [Lupron, Eligard, Viadur])
- Antiandrogens
Common side effects of LH-RH analogs
- Diarrhea
- Nausea and vomiting
- Peripheral edema
- Gynecomastia
- Hot flashes
How is Prostate cancer diagnosed?
- DRE
- PSA
- Genomics
- MRI
How do you evaluate for metastasis in prostate cancer?
Bone scan
CT
PET
Varicocele definition
dilated veins of the pampiniform plexus
Varicocele: effects
- Pain*
- Damage to testis (fibrosis and decreased sperm production, abnormal sperm)
- Testis atrophy
Varicocele Physical exam
- Supine, standing, and valsalva with standing
- “bag of worms”
- Grade I, II, III
What side does a varicocele usually occur on?
left
If a varicocele is on the right what might that indicate?
if on the right with rapid onset may indicate renal malignancy
What grade is a varicocele if it is small, not visible and only palpable with valsalva?
Grade I
What grade is moderate in size not visible, palpable with standing?
Grade II
What grade is large and grossly visible?
Grade III
Surveillance of varicocele in an young adult man
semen analysis every 1-2 years
Varicocele surveillance in children
measure testicle size annually to detect decrease in size
Varicocele surgery indication
if symptomatic and difficulty conceiving due to low quality sperm.
(3-6 months after repair, improvement in semen quality is seen in 70% of men)
Germ cell Tumors make up what percent of testicular tumors
90-95%
Seminoma or Non seminoma
Stromal tumors make up what percent of testicular tumors?
5-10%
Ex. Leydig cell, Sertoli cell, Granulosa cell
Name 4 risk factors for testicular tumors
- Cryptorchidism (undescended testicle)
- Family History
- Personal History
- HIV
Testicular tumors: Presentation
- Right side > left side
- Back pain or abdominal pain
- Painless mass or swelling in testicle
What lymph nodes do testicular tumors typically metastasize to?
retroperitoneal lymph nodes
Testicular tumor: Evaluation
- Ultrasound
- Tumor markers (Alpha-Fetoprotein, Beta-HCG, Lactate dehydrogenase)
- LFTs, CBC, Creatinine
- CXR
Post orchiectomy, how long do you wait before reassessing the tumor markers?
5 1/2 lives after proceedure
What is Testicular tumor staging based on?
Tumor, Nodes, Mets, Serum
Stage I, IIA, IIB, IIC, III (II is spread to lymph nodes)
After an ochiectomy, how often do you need to do the H&P and tumor markers?
every 3-4 months for 2 years then every 6-12 months for 2 years then... every year indefinitely (life long!*)
After an orchiectomy, how often do you need to do a CT Abd/pelvis?
every 6 months for 2 years then... every 6-12 months for 1 year then... Every year for 2 years
What are the side effects of radiation acutely versus later side efffects
Acute: nausea
Later: gastritis, increased risk of CV death, increased risk of secondary cancers
