Prostate/testicular cancer Flashcards
How many new cases of prostate cancer occur a year?
47,700 new cases/year
What is the most common cancer death in men?
Prostate cancer
How much does prostate cancer cost the NHS?
£800 million/year
What proportion of new cases of prostate cancer are >65?
75%
What proportion of new cases of prostate cancer are <50?
1%
What proportion of new cases of prostate cancer are <70?
45%
What are the risk factors for prostate cancer?
Age African/asian BRCA1/2 HPC1 First degree relative
Cancer of the prostate is more likely to be in which part of the prostate?
Peripheral zone
What proportion of newly diagnosed prostate cancers are localised?
80%
How do most prostate cancers present?
Asymptomatic
What is the diagnostic triad of prostate cancer?
DRE
PSA
TRUS-guided prostate biopsy
What are the symptoms of local prostate disease?
ASYMPTOMATIC Weak stream Hesitancy Sensation of incomplete emptying Frequency Urgency Urge incontinence UTI
What are the symptoms of locally invasive prostate disease?
Haematuria Perineal/suprapubic pain Impotence Incontinence Obstruction symptoms Renal failure Haemospermia Tenesmus
What are the symptoms of distant metastatic prostate disease?
Bone pain/sciatica Paraplegia --> spinal cord compression Lymphoedema/adenopathy Loin pain Anuria
What are the symptoms of widespread metastatic prostate disease?
Lethargy
Weight loss
Cachexia
Why is prostate cancer not screened for?
Wilson-Junger criteria not met
How is prostate cancer typically found?
Ad-hoc PSA testing
What is the upper limit for PSA in <50s?
2.5ug/mL
How does PSA vary with age?
Increases with age
What is the upper limit for PSA in 50-60s?
3.5ug/mL
What is the upper limit for PSA in 60-70s?
4.5ug/mL
What is the upper limit for PSA in >70s?
6.5ug/mL
What factors can cause an elevated PSA?
UTI Prostate exam Exercise Trauma Instrumentation BPH Prostate cancer
What is the process for PSA testing?
If repeat needed - again in 3 weeks
What cancer probability is associated with a PSA >10?
70%
What grading system is used for prostate cancer?
Gleason Grading
ISUP grading
How is a Gleason Score given to prostate cancer?
Level of differentiation in biggest area + level of differentiation in second biggest area
What are the 4 stages of prostate cancer?
Local disease
Locally advanced disease
Metastatic disease
Hormone refractory stage
What investigations are used to stage localised prostate cancer?
TRUS biopsy DRE PSA CT MRI
What investigation is used for distant staging?
CT
What are the treatment options for localised prostate cancer?
Radiotherapy
Radical prostatectomy
What is the treatment for locally advanced prostate cancer?
Hormone therapy followed by surgery
Hormone therapy followed by radiation
Hormone therapy alone
Intermitted hormone therapy
What are the types of hormonal therapy for prostate cancer?
Surgical/chemical castration
LHRH analogue/antagonist
Anti-androgens
Oestrogens
What is the prognosis of localised prostate cancer?
> 90% 15y survival
What is the prognosis of locally advanced prostate cancer?
80-90% 5y survival
What is the prognosis of metastatic prostate cancer?
3-5 years median
What is the prognosis of castrate resistant prostate cancer?
18-22mo
How does testicular cancer typically present?
Painless lump
What are the less common presentations of testicular cancer?
Tender inflamed swelling
History of trauma
Symptoms/signs from nodal or distant metastasis
What lymph nodes are associated with testicular cancer spread?
Pelvic lymph nodes
Para-aortic lymph nodes
When does incidence of testicular cancer peak?
30s
Which group is of highest risk of testicular cancer?
Whites
Testicular maldescent
Atrophic testis
Previous contralateral cancer
What is the precursor lesion of testicular cancer?
Testicular Germ cell Neoplasia in-situ
What tumour markers are associated with testicular cancer?
Alpha-fetoprotein
Beta-HCG
LDH
AFP tumour marker is raised in what?
Teratoma
BHCG tumour marker is raised in what?
Seminoma
LDH tumour marker is raised in what?
Non-specific tumour burden
How is testicular cancer diagnosed?
MSSU
Testicular ultrasound and CXR
Tumour markers
What is the differential diagnosis of testicular lumps?
Infection
Epididymal cyst
Missed testicular torsion
How is testicular cancer treated?
Radical orchidectomy
Biopsy of contralateral testis
What are the two types of testicular cancer tumour?
Germ cell and non-germ cell tumour
what are the main types of germ cell tumour?
Seminomatous (classical, spermatocytic, anaplastic)
Non-seminomatous (teratoma, yolk sack, choriocarcinoma)
What are the main types of non-GCT testicular cancer?
Leydig
Sertoli
Lymphoma
Seminoma is more common in which age group?
30-40y
Non-seminomatous cancer is more common in which age group?
20-30y
How are testicular cancers graded?
Aggressiveness
Low - high grade
Well - poorly differentiated
How are testicular cancers staged?
Spread Local Regional Distant (TNM)
How is nodal staging assessed?
CT scan
What is stage 1 testicular cancer?
Confined to testis
What is stage 2 testicular cancer?
Infradiaphragmatic nodes involved
What is stage 3 testicular cancer?
Supradiaphragmatic nodes involved
What is stage 4 testicular cancer?
Extralymphatic disease
How is low stage, negative tumour marker cancer treated?
Orchidectomy with:
Surveillance
Adjuvant radiotherapy
Prophylactic chemo
How is nodal disease, persistent tumour marker testicular cancer treated?
Combination therapy
Lymph node dissection
How are testicular cancer metastases treated?
First-line chemotherapy
Second-line chemotherapy
What is the prognosis of stage 1 testicular cancer?
99% at 5y
What is the prognosis of stage 2/3 testicular cancer?
96% at 5y
What is the prognosis of stage 4 testicular cancer?
73% at 5y