Prostate / urological cancer and Head & Neck cancer Flashcards
State the ages and frequency for cervical cancer screening
25 - 65
25-50 = every 3 years
50-65 = every 5 years
State some risk factors for prostate cancer
- Age (rare under 50)
- Close family history
- Ethnicity (African heritage)
- Genetic conditions (BRCA1 / BRCA2)
State some signs or symptoms for prostate cancer
Can be asymptomatic = had PSA
Lower urinary tract symptoms
OBSTRUCTIVE SYMPTOMS
- Hesitancy
- Poor and/or intermittent stream
- Straining
- Prolonged micturition
- Feeling of incomplete bladder emptying
- Dribbling
STORAGE SYMPTOMS
- Frequency
- Urgency
- Urge incontinence
- Nocturia
Bone pain, often back pain (metastatic)
Ejaculatory problems (rare)
State investigations in the prostate cancer diagnosis
- PSA blood test
- DRE
- Biopsy (transperineal with local anaesthetic)
- MRI prostate prior to biopsy (only if radical approach)
State some common causes of raised PSA
- Prostate cancer
- Urinary infection
- Prostatic inflammation (prostatitis)
- Large / enlarged prostate (benign prostatic hyperplasia)
- Acute urinary retention
- Vigorous exercise especially cycling
- Sexual activity
State % of patients with normal PSA can have prostate cancer
15% of patients with normal PSA can have prostate cancer
What % of men will have a raised PSA
10%
State some factors influencing treatment decisions for prostate cancer
- Age
- PSA
- MRI staging e.g. T stage and N stage
- Gleason Grade (score - low magnification grading)
- Bone scan (metastasis)
State what the Gleason’s score is and how the scoring system works
Score is based on how much the cancer looks like healthy tissue when viewed under a microscope
Biopsy area where the cancer is most obvious and another area of growth
- Each area a score from 3 to 5
- The scores are added together
- Overall score between 6 and 10 (higher the numbers, worse it is)
State the medicine used most often for hormone castration
LHRH agonist (acts on leydig cells in the testes, which then) - prevents pulsatile release of GNRH
Given for life
Initial surge in testosterone, from initial stimulation of GNRH
This is a flare - need to give an anti-androgen e.g. bicalutamide
If PS < 2 and hormone sensitive - can have chemotherapy
State some established curative intent treatments for localised (non-metastatic) prostate cancer
+ active surveillance if low risk
- Prostatectomy (robotic)
- Conformal radiotherapy (+ GnRH agonists for 3-6 months e.g. Gosarelin)
- Brachytherapy
State the treatment options for the following risk levels for non-metastatic prostate cancer:
Low risk (Gleason’s score = 6)
Intermediate risk (Gleason’s score = 7)
High risk (Gleason’s score = 9-10)
Low risk (Gleason’s score = 6):
- Active surveillance
Intermediate risk (Gleason’s score = 7):
- Active surveillance
- Radical radiotherapy (+ GnRH agonists for 3-6 months e.g. Gosarelin)
- Robotic prostatectomy
High risk (Gleason’s score = 9-10):
- Radical radiotherapy (+ GnRH agonists for 3-6 months e.g. Gosarelin)
- Robotic prostatectomy
State the follow up for prostate cancer treated radically
Check PSA levels:
– at least 6 weeks after treatment
– at least every 6 months for the first 2 years
– at least once a year after the first 2 years
After 2 years, can be discharged to primary care if PSA stable and no complications from treatment
Which patients benefit most from robotic prostatectomy
- Younger men < 70
- BMI < 35
- Localised high-risk non-metastatic prostate cancer
- Locally advanced non-metastatic
State some side effects for radical radiotherapy (prostate)
- Erectile dysfunction (up to 1/3)
- Urinary symptoms (LUTS)
- Urinary incontinence (1%)
List the potential benefits and harms of PSA screening
Benefits:
- Low cost
- More sensitive and specific that DRE alone
- Early detection of prostate cancer
Harms:
- False positives = unnecessary biopsy
- False negatives = missed cases
- Overdiagnosis = unnecessary interventions for clinically insignificant disease
- Potential complications from interventions e.g. erectile dysfunction
List some ways in which locally advanced or metastatic prostate cancer can present
- LUTS
- Back pain / pelvic pain
- Haematuria
- Haematochezia
- Haematospermia
- Spontaneous hip fracture
State some differentials for haematuria
- Cancer e.g. renal, bladder, advanced prostate
- Renal stones
- Infection
- Inflammation
- BPH / enlarged prostate
- Schistosomiasis (parasite)
- Nephritic syndrome e.g. IgA nephropathy
- Haemolytic uraemic syndrome
- Henoch-Schönlein Purpura
State some investgations for haematuria
- Urine cytology
- Flexible cystoscopy
- USS KUB or CT urogram
State 3 tumour markers for testicular cancer
- Alpha fetoprotein
- hCG
- LDH
State some risk factors for bladder cancer
- Smoking (45%)
- Occupational exposure (6%)
- Ionising radiation
State some management steps for bladder cancer based on the following severities
- Non-muscle invasive
- Muscle invasive
- Systemic
Non-muscle invasive:
- Surveillance cystoscopy (if low risk)
- Intra-vesicular chemotherapy (medium and high risk)
- Intra-vesicular BCG (high risk)
- Radical cystectomy if high risk
Muscle invasive
- Radical cystectomy
- Radiotherapy
Systemic - palliative approach:
- Chemotherapy
- Immunotherapy
State some presenting symptoms for renal cell carcinoma
- May be incidental finding
- Haematuria
- Palpable mass (adult polycystic kidney disease)
State some risk factors for penile cancer
- Increased age (over 50)
- Phimosis
- Hygeine / smegma
- HPV 16 & 18
- Psoriasis treatment (PUVA)
