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Year 2 - Renal > Prostate + testicular cancer > Flashcards

Prostate + testicular cancer Flashcards

1
Q

Prostate cancer primarily affects what age group

A

> 50

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2
Q

Risk factors of prostate cancer (4)

A

Age >50
High fat diet
Black ethnicity
Family history of prostate cancer

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3
Q

What zone of the prostate do prostate cancers usually arise in

A

peripheral zone

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4
Q

What mutations are prostate cancer associated with

A

BRCA1/BRCA2

-breast cancer genes but also present in males

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5
Q

What zone of the prostate does BPH occur in

A

Transition zone

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6
Q

Presentation of prostate cancer is mostly

A

ASYMPTOMATIC

-only found through elevated PSA mostly

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7
Q

Presentation of prostate cancer is mostly ASYMPTOMATIC

+ not usually symptomatic until locally advanced or metastatic - what symptoms (5) /signs (1) will they present with then

A 
Bone and back pain, 
Anorexia
Haematuria
Unexplained weight loss
Lethargy

Asymmetrical nodular prostate on rectal exam
Lymphadenopathy

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8
Q

Relationship between age and prostate specific antigen (produced by prostate) levels

A

increases as you age

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9
Q

Describe the sensitivity and specificity of PSA to prostate cancer

A

High sensitivity
Low specificity

PSA is PROSTATE SPECIFIC but NOT CANCER SPECIFIC

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10
Q

Why is PSA not a good screening tool for prostate cancer

A

As it’s not cancer specific, it’ll pick up lots of false positives of people who have elevated PSA but not necessarily elevated due to prostate cancer, e.g could just be BPH

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11
Q

Causes of elevated PSA levels (5)

A 
BPH 
Prostate cancer
UTI
Chronic prostatitis
Recent rectal exam
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12
Q

Rectal finding of prostate cancer on rectal examination

A

Firm nodular mass

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13
Q

Prostate cancer is graded by which scoring system

+ describe the 3 grades of this scoring system and how the total score is calculated and how this relates to aggressiveness of the cancer

A

Gleason score
-biopsy taken then cells looked at to grade it

Grades 1 and 2 are normal so technically cancer grading starts at grade 3

Grade 3 - moderately differentiated
Grade 4 - moderate to high/poor differentiation
Grade 5 - anaplastic

Total Gleason score calculated by adding together the 2 most common Gleason grades (primary grade is the one that makes up largest area of tumour then secondary grade which is the same/the next largest)

So total/sum Gleason score ranges from 6-10 (as min is 3+3 and max is 5+5)

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14
Q

A total/sum Gleason score of 7 indicates an intermediate risk for aggressive cancer

The primary and secondary score could’ve been what combinations

A

Either 3+4 - better outlook

Or 4+3 - poorer outlook

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15
Q

Difference between grading and staging of a cancer

A

Grading refers to the aggressiveness of the cancer, i.e. how well or poor the cells are differentiated

Staging refers to the spread of the cancer

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16
Q

Investigations of prostate cancer

  • biochemical tests (1)
  • staging investigations (4)
A

Serum PSA

Staging

  • prostate biopsy –> GLEASON SCORE
  • plain XR - to see any bone mets
  • pelvic CT - to assess prostate size and pelvic lymph node
  • pelvic MRI
17
Q

Examination of prostate cancer

A

Rectal examination

18
Q

What lymph nodes does prostate cancer spread to

A

Pelvic

19
Q

Treatment of localised prostate cancer (i.e. hasn’t spread outwith prostate) (4)

A

Active surveillance until symptomatic

External beam radiotherapy
or
Brachytherapy
or
Radical prostatectomy
20
Q

Treatment of locally advanced prostate cancer (4)

A

Active surveillance until symptomatic

Hormone therapy before and after external beam
radiotherapy
or
Hormone therapy before and after brachytherapy
or
Hormone therapy before and after radical prostatectomy

21
Q

Hormone therapy is used for what forms of prostate cancer

A

Locally advanced and metastatic; NOT LOCALISED

22
Q

How does hormone therapy work in prostate cancer

A

Decreases testosterone levels in order to decrease cancer cell growth as prostate cancer growth is stimulated by testosterone

23
Q

3 types of hormone therapy for prostate cancer

A

Injections/impants

  • gonadotropin-releasing hormone (GnRH) AGONIST combined with anti-androgens (more used than below)
  • gonadotropin-releasing hormone (GnRH) ANTAGONIST

Tablets
-anti-androgens (stop testosterone from getting to cancer cells by inhibiting androgen receptors)

Surgery
-orchidectomy (remove testicles so remove testosterone production)

24
Q

1st line treatment for metastatic prostate cancer

A

Hormone therapy

25
Q

Presentation of testicular cancer is usually just…

A

hard painless nodule on one testis

26
Q

Testicular cancer commonly affects what age group

A

Young adults 20-34

27
Q

Risk factors of testicular cancer (4)

A

Undescended testicles (cryptorchidism)
Family history of testicular cancer
Previous history of testicular cancer
Testicular atrophy

28
Q

Most common type of testicular cancer

A

Germ cell tumour (95%)

-seminoma (commonest) or non seminoma

29
Q

Investigations of testicular cancer

  • initial imaging (1)
  • staging imaging (2)
  • serum tumour markers (3)
A

USS of testis - PRINCIPLE

CT abdo/pelvis - for metastases
CXR - for metastases

Serum AFP
Serum beta-hCG
Serum lactate dehydrogenase (LDH)

30
Q

The following tumour markers are markers of what type of testicular cancer

  • Serum AFP
  • Serum beta-hCG
  • Serum lactate dehydrogenase (LDH)
A

AFP - embryonal carcinoma, teratoma, yolk sac tumours

beta-hCG - seminomas. choriocarcinomas

LDH - not specific to testicular cancer, just marker of tumour burden

31
Q

Treatment of testicular cancer

A

Radical orchidectomy

+/- radiotherapy or chemotherapy post surgery

32
Q

Testicular cancer spreads to what lymph nodes

A

Para-aortic

33
Q

Testicular cancer spreads to (3)

A

Lungs
Bone
Liver

Year 2 - Renal (21 decks)

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