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Renal > Tumours of the Urinary System 1 (Prostate Cancer and Testicular Cancer) > Flashcards

Tumours of the Urinary System 1 (Prostate Cancer and Testicular Cancer) Flashcards

1
Q

At what age do men tend to get diagnosed with prostate cancer?

A

75% of new cases are aged >65 years

1% of new cases are aged <50 years

However, 45% of new cases <70 years

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2
Q

How does prostate cancer tend to present?

A
  • Mostly asymptomatic

- May have bladder outflow obstruction
weak stream / urgency / incontinence / incomplete emptying

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3
Q

What is the optimal diagnostic triad for prostate cancer?

A

PSA (prostate specific antigen)

Digital rectal examination

TRUS-guided prostate biopsies

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4
Q

What are normal and age adjusted values for PSA testing?

A 
Normal serum range 0-4.0 microg/mL
Age-related range - Levels increase 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
>70 years : 6.5 is upper limit
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5
Q

What are some possible causes of elevated PSA?

A
  • UTI
  • chronic prostatitis
  • instrumentation (e.g. catheterisation)
  • recent urological procedure
  • BPH (benign prostatic hyperplasia)
  • prostate cancer
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6
Q

What is the probability of prostate cancer based on different PSA levels?

A
  1. 5–4.0: 25%
  2. 0-10: 40%

> 10: 70%

(looking for a value over 10microg/mL)

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7
Q

What scale is used to grade prostate cancer? What values indicate an aggressive cancer?

A
  • Gleason Score

Scores of 6 or less suggest that the cancer is likely to grow slowly. Scores of 8 or higher describe cancers that are likely to spread more rapidly.

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8
Q

What are the 4 “stages” prostate cancers are often divided into?

A
  1. Localised stage
  2. Locally advanced stage
  3. Metastatic stage
  4. Hormone refractory stage
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9
Q

What investigations are used to stage prostate cancer?

A 
Digital rectal examination (local staging)
PSA
Transrectal US guided biopsies
CT (regional and distant staging)
MRI (local staging)
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10
Q

What are the treatment options for localized prostate cancer?

A
  • Radiotherapy
  • Radical prostatectomy (open / laparoscopic / robotic laparoscopic)
  • Hormone therapy
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11
Q

What are some hormone therapy options for the treatment of prostate cancer?

A
  • Surgical castration (bilateral orchidectomy - christ)
  • Chemical castration (LHRH analogues)
  • Anti-androgens
  • Oestrogens
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12
Q

What are some presentations of testicular cancer?

A
  • Usually: painless mass

Less often: tender swelling, metastatic symptoms

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13
Q

Who is most at risk of testicular cancer?

A
  • Men in third decade

- Caucasians

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14
Q

What are some serum biomarkers that can indicate testicular cancer?

A

AFP (alpha-fetoprotein) (teratoma)

(beta)HCG (Human Chorionic Gonadotrophin) (seminoma)

LDH (Lactate dehydrogenase) (non-specific marker of tumour burden)

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15
Q

What investigations can be done for diagnosis of testicular cancer?

A
  • Serum biomarkers
  • testicular palpation
  • MSSU
  • Testicular USS
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16
Q

What is the usual treatment plan for testicular cancer?

A
  • Radical orchidectomy
  • Chemo / radiotherapy as needed
  • Biopsy contralateral testicle if high tumour risk
17
Q

What is the most common type of testicular cancer? What are the two divisions of this type of cancer?

A

Germ cell tumour (GCT)

  • Seminoma: tend to spread slowly. Secrete human chorionic gonadotropin (HCG)
  • Nonseminomatous: variable in appearance and prognosis. Secrete alpha fetoprotein (AFP) mostly (can secrete HCG in some cases)
18
Q

Which groups of men are typically affected by seminomas and nonseminomatous tumours?

A

Seminoma
Mainly affects 30-40 year olds

Non-seminomatous
Mainly affect 20-30 year-old

19
Q

How are testicular tumours graded?

A

Grading based on aggressiveness, which is determined by level of differentiation of tumour cells

  • Low grade = well differentiated
  • High grade = poorly differentiated
20
Q

How are testicular cancers staged? What investigations are used for staging?

A

Staged based on level of spread (TNM staging)

Local staging (via pathological assessment of orchidectomy specimen)
Nodal staging (via CT scan)
Distant staging (chest, abdomen and pelvis via CT scan)
21
Q

What are the stages of testicular cancer?

A

Stage I - disease is confined to the testis

Stage II - Infradiaphragmatic nodes involved

Stage III - Supradiaphragmatic nodes involved

Stage IV - extralymphatic disease

22
Q

What is the prognosis like for testicular cancer?

A

Depends on stage, but good if treated:

Stage 1: 5-year survival – 99%
Stage 2/3: 5-year survival – 96%
Stage 4: 5-year survival – 73%

Renal (30 decks)

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