Prostate Cancer, Varicocele, Testicular tumors

Question 1

PSA density

Answer 1

serum PSA concentration divided by prostate volume

> .15 may be significant

-Helpful in differentiating cancer from BPH

Question 2

Symptoms of metastasis

Answer 2

• bone pain
• weight loss
• anemia
• azotemia
• fatigue
• dyspnea
• Lymphedema
• Ureteral obstruction

Question 3

Adverse effects of radical prostatectomy

Answer 3

• impotence
• bladder neck contractures
• incontinence

Question 4

Name 3 hormonal manipulation therapies

Answer 4

1. Bilateral orchiectomy
2. LH-RH analogs (Leuprolide [Lupron, Eligard, Viadur])
3. Antiandrogens

Question 5

Common side effects of LH-RH analogs

Answer 5

• Diarrhea
• Nausea and vomiting
• Peripheral edema
• Gynecomastia
• Hot flashes

Question 6

How is Prostate cancer diagnosed?

Answer 6

• DRE
• PSA
• Genomics
• MRI

Question 7

How do you evaluate for metastasis in prostate cancer?

Answer 7

Bone scan
CT
PET

Question 8

Varicocele definition

Answer 8

dilated veins of the pampiniform plexus

Question 9

Varicocele: effects

Answer 9

• Pain*
• Damage to testis (fibrosis and decreased sperm production, abnormal sperm)
• Testis atrophy

Question 10

Varicocele Physical exam

Answer 10

• Supine, standing, and valsalva with standing
• “bag of worms”
• Grade I, II, III

Question 11

What side does a varicocele usually occur on?

Answer 11

left

Question 12

If a varicocele is on the right what might that indicate?

Answer 12

if on the right with rapid onset may indicate renal malignancy

Question 13

What grade is a varicocele if it is small, not visible and only palpable with valsalva?

Answer 13

Grade I

Question 14

What grade is moderate in size not visible, palpable with standing?

Answer 14

Grade II

Question 15

What grade is large and grossly visible?

Answer 15

Grade III

Question 16

Surveillance of varicocele in an young adult man

Answer 16

semen analysis every 1-2 years

Question 17

Varicocele surveillance in children

Answer 17

measure testicle size annually to detect decrease in size

Question 18

Varicocele surgery indication

Answer 18

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)

Question 19

Germ cell Tumors make up what percent of testicular tumors

Answer 19

90-95%

Seminoma or Non seminoma

Question 20

Stromal tumors make up what percent of testicular tumors?

Answer 20

5-10%

Ex. Leydig cell, Sertoli cell, Granulosa cell

Question 21

Name 4 risk factors for testicular tumors

Answer 21

1. Cryptorchidism (undescended testicle)
2. Family History
3. Personal History
4. HIV

Question 22

Testicular tumors: Presentation

Answer 22

• Right side > left side
• Back pain or abdominal pain
• Painless mass or swelling in testicle

Question 23

What lymph nodes do testicular tumors typically metastasize to?

Answer 23

retroperitoneal lymph nodes

Question 24

Testicular tumor: Evaluation

Answer 24

• Ultrasound
• Tumor markers (Alpha-Fetoprotein, Beta-HCG, Lactate dehydrogenase)
• LFTs, CBC, Creatinine
• CXR

Question 25

Post orchiectomy, how long do you wait before reassessing the tumor markers?

Answer 25

5 1/2 lives after proceedure

Question 26

What is Testicular tumor staging based on?

Answer 26

Tumor, Nodes, Mets, Serum Stage I, IIA, IIB, IIC, III (II is spread to lymph nodes)

Question 27

After an ochiectomy, how often do you need to do the H&P and tumor markers?

Answer 27

``` every 3-4 months for 2 years then every 6-12 months for 2 years then... every year indefinitely (life long!*) ```

Question 28

After an orchiectomy, how often do you need to do a CT Abd/pelvis?

Answer 28

``` every 6 months for 2 years then... every 6-12 months for 1 year then... Every year for 2 years ```

Question 29

What are the side effects of radiation acutely versus later side efffects

Answer 29

Acute: nausea Later: gastritis, increased risk of CV death, increased risk of secondary cancers