Prostatic and Bladder Cancer Flashcards
What is the apex of the prostate continuous with?
striated spincter
What is the base of the prostate continuous with?
bladder neck
What is the ejacultory duct?
union of seminal vesicles and vas deferens
What is the verumontanum?
elevation in the prostatic urethra where the ejacultory ducts drain
What is the transitional zone of the prostate?
surrounds the prostatic urethra proximal to the verumontanum which gives rise to BPH
What is the central zone of the prostate?
cone shaped region that surround the ejaculatory ducts
What is the peripheral zone of hte prostate?
posteriolateral prostate- majority of prostatic glandular tissue
Where does the majority of prostate adenocarcinoma arise from?
peripheral zone
What ethnicity has the greatest risk of prostate cancer?
black men
How are most prostatic cancers picked up?
PSA tests and abnormal DRE findings
What is found on DRE with prostate cancer?
asymmetry; nodule; fixed craggy mass
What is prostate specific antigen?
a glycoprotein enzyme produced by the secretory epithelial cells of the prostate
What is the function of PSA?
liquefaction of semen
What can elevate PSA aside from prostate cancer?
BPH; prostatitis/UTI; retention; catheterization; DRE
What are teh indications for trans-rectal USS guided prostate biopsy?
men with abnormal DRE or eleated PSA
What are the complications of TRUS?
sepsis; rectal bleeding; haematospermia and haematuria
What type of cancer are the majority of prostate cancers?
multifocal adenocarcinomas
What is the pattern of growth with prostate cancer?
local extension through the prostatic capsule, to the urethra, bladder base and seminal vedicals with perineural invasion along autonomic nerves
Where are the most common sites for mets with prostate cancer?
pelvic lymph nodes and the skeleton
What is the Gleason’s score system?
based on the architectural appearance rather than cytological features of CaP
What increases the Gleason score?
loss of the glandular structure and replacement by a disorganised malignant cell growth pattern
Why is Gleason’s score used?
a very good predictor of prognosis
What is the T3 PaC?
tumour has extended through the prostatic capsule
What are the complications of radical prostatectomy?
erectile dysfucntion; incontinence; bladder neck stenosis
What are the complications of radical radiotherapy for CaP?
irritative LUTS; haematuria; GI symptoms; erectile dysfunction; incontinence
What is the hormonal therapy for CaP?
LNRH (GNRH) analogues; anti-androgens; bilateral subcapsular orchidectomy; maximal androgen blockade
What is growth of prostate cancer cells under the influence of?
testosterone and dihyrotestosterone
Where does testosterone come from?
90%- testis; adrenals
What happens if prostate cells are deprived of androgenic stimulation?
undergo apoptosis
What happens with chronic exposure to LNRH agonists?
down-regulation of LNRH receptors with subsequent suppression of LH and FSH
What can happen initially with LNRH analogues?
initially have transient rise in LH and FSH and so testosterone
What complication can happen with the testosterone surge phenomenon?
spinal cord compression
What is given before and during initial treatment with LNRH agonists to prevent spinal cord compression?
anti-androgen covers
What are the side effects of LNRH agonists?
ED; hot flushes and sweats; weight gain; gynaecomastia; anaemia; cognitive changes; OP
What is the action of anti-androgens?
compete with testosterone for binding sites in the prostate cell nucleus to promote apoptosis
What are the 2 types of anti-androgens?
steroidal and non-steroidal
What are the side effects of cyproterone (stseroidal anti-androgen)?
loss of libido and ED; gynaecomastia; CVS toxicity and hepatotoxicity
hat are the SE and non-steroidal anti-androgens (nilutamide, flutamide)?
gyaecomastia, breast plain and hot flashes and hepatotoxicity but retain sexual interest
What are the 2 main types of bladder cancer?
mainly transitional cell, some squamous
What is the classification of transitional cell carcinoma?
papillary and non-papillary
What is the more common typ of transitional cell carcinoma?
papillary type
What is the difference between papillary nad non-papillary carcinoma?
papillary only half are infiltrative malignances whereas all non-papillary are considered malignent
What is the investigations for bladder carcinoma?
CT urography and cystoscopy
What is squamou cell carcinoma of the bladder associated with?
schistosomiasis
