Prostate + testicular cancer Flashcards
Prostate cancer primarily affects what age group
> 50
Risk factors of prostate cancer (4)
Age >50
High fat diet
Black ethnicity
Family history of prostate cancer
What zone of the prostate do prostate cancers usually arise in
peripheral zone
What mutations are prostate cancer associated with
BRCA1/BRCA2
-breast cancer genes but also present in males
What zone of the prostate does BPH occur in
Transition zone
Presentation of prostate cancer is mostly
ASYMPTOMATIC
-only found through elevated PSA mostly
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
Bone and back pain, Anorexia Haematuria Unexplained weight loss Lethargy
Asymmetrical nodular prostate on rectal exam
Lymphadenopathy
Relationship between age and prostate specific antigen (produced by prostate) levels
increases as you age
Describe the sensitivity and specificity of PSA to prostate cancer
High sensitivity
Low specificity
PSA is PROSTATE SPECIFIC but NOT CANCER SPECIFIC
Why is PSA not a good screening tool for prostate cancer
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
Causes of elevated PSA levels (5)
BPH Prostate cancer UTI Chronic prostatitis Recent rectal exam
Rectal finding of prostate cancer on rectal examination
Firm nodular mass
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
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)
A total/sum Gleason score of 7 indicates an intermediate risk for aggressive cancer
The primary and secondary score could’ve been what combinations
Either 3+4 - better outlook
Or 4+3 - poorer outlook
Difference between grading and staging of a cancer
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
Investigations of prostate cancer
- biochemical tests (1)
- staging investigations (4)
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
Examination of prostate cancer
Rectal examination
What lymph nodes does prostate cancer spread to
Pelvic
Treatment of localised prostate cancer (i.e. hasn’t spread outwith prostate) (4)
Active surveillance until symptomatic
External beam radiotherapy or Brachytherapy or Radical prostatectomy
Treatment of locally advanced prostate cancer (4)
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
Hormone therapy is used for what forms of prostate cancer
Locally advanced and metastatic; NOT LOCALISED
How does hormone therapy work in prostate cancer
Decreases testosterone levels in order to decrease cancer cell growth as prostate cancer growth is stimulated by testosterone
3 types of hormone therapy for prostate cancer
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)
1st line treatment for metastatic prostate cancer
Hormone therapy
Presentation of testicular cancer is usually just…
hard painless nodule on one testis
Testicular cancer commonly affects what age group
Young adults 20-34
Risk factors of testicular cancer (4)
Undescended testicles (cryptorchidism)
Family history of testicular cancer
Previous history of testicular cancer
Testicular atrophy
Most common type of testicular cancer
Germ cell tumour (95%)
-seminoma (commonest) or non seminoma
Investigations of testicular cancer
- initial imaging (1)
- staging imaging (2)
- serum tumour markers (3)
USS of testis - PRINCIPLE
CT abdo/pelvis - for metastases
CXR - for metastases
Serum AFP
Serum beta-hCG
Serum lactate dehydrogenase (LDH)
The following tumour markers are markers of what type of testicular cancer
- Serum AFP
- Serum beta-hCG
- Serum lactate dehydrogenase (LDH)
AFP - embryonal carcinoma, teratoma, yolk sac tumours
beta-hCG - seminomas. choriocarcinomas
LDH - not specific to testicular cancer, just marker of tumour burden
Treatment of testicular cancer
Radical orchidectomy
+/- radiotherapy or chemotherapy post surgery
Testicular cancer spreads to what lymph nodes
Para-aortic
Testicular cancer spreads to (3)
Lungs
Bone
Liver
