Prostatic and Bladder Cancer

Question 1

What is the apex of the prostate continuous with?

Answer 1

striated spincter

Question 2

What is the base of the prostate continuous with?

Answer 2

bladder neck

Question 3

What is the ejacultory duct?

Answer 3

union of seminal vesicles and vas deferens

Question 4

What is the verumontanum?

Answer 4

elevation in the prostatic urethra where the ejacultory ducts drain

Question 5

What is the transitional zone of the prostate?

Answer 5

surrounds the prostatic urethra proximal to the verumontanum which gives rise to BPH

Question 6

What is the central zone of the prostate?

Answer 6

cone shaped region that surround the ejaculatory ducts

Question 7

What is the peripheral zone of hte prostate?

Answer 7

posteriolateral prostate- majority of prostatic glandular tissue

Question 8

Where does the majority of prostate adenocarcinoma arise from?

Answer 8

peripheral zone

Question 9

What ethnicity has the greatest risk of prostate cancer?

Answer 9

black men

Question 10

How are most prostatic cancers picked up?

Answer 10

PSA tests and abnormal DRE findings

Question 11

What is found on DRE with prostate cancer?

Answer 11

asymmetry; nodule; fixed craggy mass

Question 12

What is prostate specific antigen?

Answer 12

a glycoprotein enzyme produced by the secretory epithelial cells of the prostate

Question 13

What is the function of PSA?

Answer 13

liquefaction of semen

Question 14

What can elevate PSA aside from prostate cancer?

Answer 14

BPH; prostatitis/UTI; retention; catheterization; DRE

Question 15

What are teh indications for trans-rectal USS guided prostate biopsy?

Answer 15

men with abnormal DRE or eleated PSA

Question 16

What are the complications of TRUS?

Answer 16

sepsis; rectal bleeding; haematospermia and haematuria

Question 17

What type of cancer are the majority of prostate cancers?

Answer 17

multifocal adenocarcinomas

Question 18

What is the pattern of growth with prostate cancer?

Answer 18

local extension through the prostatic capsule, to the urethra, bladder base and seminal vedicals with perineural invasion along autonomic nerves

Question 19

Where are the most common sites for mets with prostate cancer?

Answer 19

pelvic lymph nodes and the skeleton

Question 20

What is the Gleason’s score system?

Answer 20

based on the architectural appearance rather than cytological features of CaP

Question 21

What increases the Gleason score?

Answer 21

loss of the glandular structure and replacement by a disorganised malignant cell growth pattern

Question 22

Why is Gleason’s score used?

Answer 22

a very good predictor of prognosis

Question 23

What is the T3 PaC?

Answer 23

tumour has extended through the prostatic capsule

Question 24

What are the complications of radical prostatectomy?

Answer 24

erectile dysfucntion; incontinence; bladder neck stenosis

Question 25

What are the complications of radical radiotherapy for CaP?

Answer 25

irritative LUTS; haematuria; GI symptoms; erectile dysfunction; incontinence

Question 26

What is the hormonal therapy for CaP?

Answer 26

LNRH (GNRH) analogues; anti-androgens; bilateral subcapsular orchidectomy; maximal androgen blockade

Question 27

What is growth of prostate cancer cells under the influence of?

Answer 27

testosterone and dihyrotestosterone

Question 28

Where does testosterone come from?

Answer 28

90%- testis; adrenals

Question 29

What happens if prostate cells are deprived of androgenic stimulation?

Answer 29

undergo apoptosis

Question 30

What happens with chronic exposure to LNRH agonists?

Answer 30

down-regulation of LNRH receptors with subsequent suppression of LH and FSH

Question 31

What can happen initially with LNRH analogues?

Answer 31

initially have transient rise in LH and FSH and so testosterone

Question 32

What complication can happen with the testosterone surge phenomenon?

Answer 32

spinal cord compression

Question 33

What is given before and during initial treatment with LNRH agonists to prevent spinal cord compression?

Answer 33

anti-androgen covers

Question 34

What are the side effects of LNRH agonists?

Answer 34

ED; hot flushes and sweats; weight gain; gynaecomastia; anaemia; cognitive changes; OP

Question 35

What is the action of anti-androgens?

Answer 35

compete with testosterone for binding sites in the prostate cell nucleus to promote apoptosis

Question 36

What are the 2 types of anti-androgens?

Answer 36

steroidal and non-steroidal

Question 37

What are the side effects of cyproterone (stseroidal anti-androgen)?

Answer 37

loss of libido and ED; gynaecomastia; CVS toxicity and hepatotoxicity

Question 38

hat are the SE and non-steroidal anti-androgens (nilutamide, flutamide)?

Answer 38

gyaecomastia, breast plain and hot flashes and hepatotoxicity but retain sexual interest

Question 39

What are the 2 main types of bladder cancer?

Answer 39

mainly transitional cell, some squamous

Question 40

What is the classification of transitional cell carcinoma?

Answer 40

papillary and non-papillary

Question 41

What is the more common typ of transitional cell carcinoma?

Answer 41

papillary type

Question 42

What is the difference between papillary nad non-papillary carcinoma?

Answer 42

papillary only half are infiltrative malignances whereas all non-papillary are considered malignent

Question 43

What is the investigations for bladder carcinoma?

Answer 43

CT urography and cystoscopy

Question 44

What is squamou cell carcinoma of the bladder associated with?

Answer 44

schistosomiasis