Tumours of the urinary system 1 - prostate and testicular Flashcards
What age is prostate cancer most common?
over 65
Describe the epidemiology of prostate cancer
most common cancer diagnosis in men
2nd most common cause of death in men - cancer
Risk factors for prostate cancer
age race/ethnicity - African living in western countries family history food - probable drugs - 5 alpha reductase inhibitors geography
What do 5 alpha reductase inhibitors do to the prostate cancer risk?
relative reduced risk 25-30%
increase risk of high grade tumours
Where do each of these develop in the prostate zones?
1 - BPH
2 - prostate cancer
1 - transitional
2 - peripheral
What cell type is prostate cancer?
adenocarcinoma
How are most prostate cancers picked up?
opportunistic PSA testing
Diagnostic triad of prostate cancer
PSA
digital rectal examination
TRUS guided biopsy
Is PSA specific?
prostate specific but not cancer specific
Localised prostate cancer symptoms (? more to do with BPH)
weak stream, hesitancy, sensation of incomplete emptying, frequency, urgency, urge incontinence, urinary tract infection
Locally invasive disease symptoms
haematuria perineal and suprapubic pain impotence incontinence loin pain or anuria due to ureter obstruction symptoms of renal failure
Distant mets symptoms
bone pain or sciatica
lymph node enlargement
paraplegia - spinal cord compression
Widespread mets symptoms
lethargy - anaemia, uraemia
weight loss and cachexia
Why is prostate cancer not screened for?
Wilson-junger criteria not met
does not improve survival
leads to over diagnosis & treatment
Basis of PSA
kallikrein serine protease helps liquify semen and produced by prostate - may leak into serum
Threshold for PSA is dependent on?
age
7 reasons for increased PSA levels
BPH prostate cancer chronic prostatitis instrument eg catheter urological procedure physiological eg ejaculation UTI
Half life of PSA
2.2 days
If repeat PSA needed when would it be done?
3 weeks eg 8 half lives later
What is meant by grading of cancer?
how aggressive it is histologically
Levels of grading in prostate cancer
3 to 5
3 well differentiated and 5 poor
How is the grading of prostate cancer done?
gleason SUM score