Tumours of the urinary system 1 (Testicular and Prostate cancer) Flashcards
What is the most common cancer diagnosed in men?
Prostate cancer
Aetiology and RFs for prostate cancer
Age
Race/Ethnicity
Geography
Family history - first degree relative 2x risk
Which genes are related to prostate cancer?
HPC1
BRAC1 and 2
What are McNeal’s’ prostatic zones?
Transition zone
Central zone
Anterior fibromuscular stroma
Peripheral zone
4 areas of the prostate
Which zone is most commonly affected?
Peripheral zone
80% of newly diagnosed prostate cancers are what?
Localised
How are most prostate cancer cases diagnosed
Incidentally through opportunistic PSA testing as most patients are asymptomatic
At present, is there a screening programme for prostate cancer?
No
What is the PSA test
A blood test to help detect prostate cancer - it’s not completely reliable though.
It’s prostate specific but not necessarily cancer-specific
What triad of tests are used in the diagnosis of prostate cancer?
PSA test
Digital rectal examination (rectal exam)
TRUS-guided prostate biopsies
Symptoms of local invasive disease associated with prostate cancer
Haematuria
Perineal and suprapubic pain
Impotence - can’t get an erection or orgasm
Incontinence
Loin pain or anuria - obstruction of ureters
Symptoms of renal failure
Haemospermia - blood in semen
Symptoms of metastatic prostate cancer
Bone pain or sciatica
Paraplegia secondary to spinal cord compression
Lymph node enlargement
Lymphoedema - particularly in lower limbs
Loin pain or anuria due to obstruction of the ureters by lymph nodes
Widespread metastases - lethargy, weight loss and cachexia
Why can screening be detrimental?
It leads to over-diagnosis and over-treatment of harmless cancers
How can under-treatment of aggressive cancers (like prostate cancer) be avoided?
Ad-hoc PSA testing
What does the PSA test detect?
Prostate specific antigen
It’s produced by glands of the prostate - may leak into the serum
Levels in serum increase with age
What is the normal range of Kallikrein serine protease in serum?
0-4.0 ug/ml
When might you expect to see an elevation in PSA (6)
UTI Chronic prostatitis Instrumentation - catheterisation Physiological - ejaculation BPH - enlarged prostate Prostate cancer
What is the probability of cancer in relation to levels of PSA?
0-1.0 = 5% 2.5-4.0 = 25% >10 = 70%
What is the name given to the grading score for prostate cancer
Gleason grading of prostate cancer
score 3-5 (well to poorly differentiated)
Useful prognostically and guides treatment
Summated to give Gleason SUM core
How does the ISUP grade group work?
Grades prostate cancer from 1-5
For purposes of treatment and prognosis prostate cancer is divided into 4 stages, what are they?
Localised stage
Locally advanced stage
Metastatic stage
Hormone refractory stage - no longer responds to hormone therapy
What investigations/imaging can be done to stage localised prostate cancer?
Digital rectal examination (local staging)
PSA
Transrectal US guided biopsies
CT (regional and distant staging)
MRI (local staging)
Treatment options for localised prostate cancer?
Watchful waiting
Radiotherapy
Radical prostatectomy
Cryotherpay, thermotherapy
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)
