Tumours of the Urinary System 1 (Prostate and Testicular Cancers) Flashcards
What is the commonest cancer in men?
Prostate cancer
What is the incidence of prostate cancer?
- 134/100000 men/year
How does the incidence of prostate cancer change with age?
- Incidence increases with age
What are risk factors for prostate cancer?
- Age
- Race/ethnicity
- Geography
- Family history
- First degree relative is 2x risk
- HPC1, BRCA1 and 2
What genes are linked to prostate cancer?
- HPC1, BRCA1 and 2
How does most prostate cancer present?
- 80% of newly diagnosed prostate cancers are localised
- Mostly asymptomatic (do not have cancer specific symptoms)
How is prostate cancer diagnosed?
- Diagnosed through opportunistic PSA testing (not screening)
- Diagnostic triad of PSA, digital rectal examination and TRUS-guided prostate biopsies
What are some localised prostate cancer presenting symptoms?
What is the presentation of metastatic prostate cancer?
Is prostate cancer screened for?
Screening is not done for prostate cancer, but ad-hoc PSA testing is:
- Kallikrein serine protease (liquifies semen)
- Produced by glands of prostate
- Normal serum range is 0-4ug/mL
- Levels change with age
- <50 years, 2.5 is upper limit
- 50-60 years 3.5 is upper limit
- 60-70 years 4.5 is upper limit
- 6.5 years 6.5 is upper limit
- Levels change with age
What is the normal serum range of Kallikrein serine protease?
- Normal serum range is 0-4ug/mL
- Levels change with age
- <50 years, 2.5 is upper limit
- 50-60 years 3.5 is upper limit
- 60-70 years 4.5 is upper limit
- Levels change with age
6.5 years 6.5 is upper limit
What does PSA testing measure?
Kallikrein serine protease
Elevations in PSA can occur due to?
- UTI
- Chronic prostatitis
- Instrumentation (catheterisation)
- Physiological (ejaculation)
- Recent urological procedure
- BPH
- Prostate cancer
What is the half life of PSA?
2.2 days
If repeated PSA tests are needed, how long should be waited before rechecking?
If repeat PSA needed, recheck in at least 3 weeks (ie 8 half lifes)
What is the probability of cancer based on PSA levels?
What is used to grade prostate cancers pathologically?
Gleason grading of prostate cancer:
- Pathologist classifies grade of prostate cancer
- Score 3 to 5 (well to poorly differentiated)
- Summate to give Gleason SUM score
- Useful prognostically and guides treatment
What are Gleason gradings converted into?
ISUP grade
For purposes of treatment and prognosis, it is useful to divide prostate cancer into 4 stages, what are these?
- Localised stage
- Locally advanced stage
- Metastatic stage
- Hormone refractory stage
What can staging of localised prostate cancer be done by?
- Digital rectal examination (local staging)
- PSA
- Transrectal US guided biopsies
- CT (regional and distant staging)
- MRI (local staging)
What is the treatment of localised prostate cancer?
- Radiotherapy
- External-beam
- Brachytherapy
- Radical prostatectomy
- Open
- Laparoscopic
- Robotic
- Others under investigation
- Cryotherapy
- Thermotherapy
What is the treatment of locally advanced prostate cancer?
- Watchful waiting
- Hormone therapy followed by surgery
- Hormone therapy followed by radiation
- Hormone therapy alone
- Intermitted hormone therapy (clinical research)
What are different types of hormonal treatment for prostate cancer?
- Surgical castration
- Ie bilateral orchidectomy
- Chemical castration
- Ie LHRH analogue or LHRH antagonists
- LHRH analogues eventually downregulates androgen receptors by negative feedback
- Tumour flare in first week of therapy, LHRH antagonists do not cause tumour flair
- Ie LHRH analogue or LHRH antagonists
- Anti-androgens
- Inhibit androgen receptors
- Oestrogens
- Inhibits LHRH and testosterone secretion inactivates androgens and has direct cytotoxic effects on prostatic epithelial cells
What are examples of chemical castration?
- Ie LHRH analogue or LHRH antagonists
- LHRH analogues eventually downregulates androgen receptors by negative feedback
- Tumour flare in first week of therapy, LHRH antagonists do not cause tumour flair
How does oestrogen hormonal therapy for prostate cancer work?
- Inhibits LHRH and testosterone secretion inactivates androgens and has direct cytotoxic effects on prostatic epithelial cells
What are some metastatic prostate cancer complications?
- Bone
- Pain, pathological fractures, anaemic, spinal cord compression
- Rectal
- Constipation, bowel obstruction
- Ureteric
- Obstruction from renal failure
- Pelvic lymphatic obstruction
- Lymphoedema, DVT
- Lower urinary tract dysfunction
Haematuria, acute retention