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*Urinary System > Tumours of the Urinary System (Prostate + Testicular Cancer) > Flashcards

Tumours of the Urinary System (Prostate + Testicular Cancer) Flashcards

1
Q

What is the commonest cancer diagnosed in men?

A

Prostate

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2
Q

5 aetiologies/risk factors for prostate cancer?

A
  • Age
  • Race/ethnicity - African or Afro-Caribbean men living in Western countries vs East Asian or Asian men living in Western countries
  • Geography - Northwestern Europe/Nort America/Caribbean/Australia vs Asia/Africa/Central + South America
  • Family history - first degree relative 2x risk; HPC1; BRCA1 + 2
  • Food (only probable) - selenium, lycopenes/carotenoids, vit E, omega 3 FA
  • Drugs - Finasteride
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3
Q

Review of McNeal’s prostatic zones

A

Transition zone

Central zone

Peripheral zone

Anterior fibromuscular stroma

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4
Q

Where does prostate cancer most commonly arise?

A

Peripheral zone

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5
Q

What do most prostate cancers present as clinically?

A

Asymptomatic

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6
Q

How is prostate cancer diagnosed?

A

Through opportunistic PSA testing (not screening!)

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7
Q

What is the diagnostic triad of prostate cancer?

A

PSA (prostate-specific antigen)

Digital rectal examination

TRUS-guided prostate biopsy

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8
Q

What is PSA?

A

Prostate-specific antigen

(not necessarily cancer specific!)

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9
Q

Give presenting symptoms of local disease in prostate cancer?

A
  • Weak stream*
  • Hesitancy*
  • Sensation of incomplete emptying*
  • Frequency*
  • Urgency*
  • Urge incontinence*
  • UTI*
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10
Q

Give presenting symptoms of locally invasive disease in prostate cancer?

A

Haematuria

Perineal adn suprapubic pain

Impotence

Incontinence

Loin pain or anuria resulting from obstruction of the ureters

Symptoms of renal failure

Heamospermia

Rectal symptoms inc tenesmus

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11
Q

What percentage of newly diagnosed prostate cancers are localised?

A

80%

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12
Q

Give presenting features of DISTANT METASTASES in prostate cancer

A
  • Bone pain/sciatica
  • Paraplegia secondary to spinal cord compression
  • Llymph node enlargement
  • Lymphoedema, particularly in the lower limbs
  • Loin pain or anuria due to obstruction of the ureters by lymph nodes
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13
Q

Give the presenting symptoms of WIDESPREAD METASTASES in prostate cancer

A
  • Lethargy (e.g. due to anaemia, uraemia)
  • Weight loss and cachexia
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14
Q

MCQ - what is the commonest mode of presentation for prostate cancer?

A

Asymptomatic

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15
Q

Why is prostate cancer not screened for?

A

Wilson-Junger criteria not met

Level 1 evidence (i.e. RCTs and meta-analysis) that screening does not imprive cancer-specific mortality (compared with standard practice)

Screening leads to over-diagnosis and over-treatment of harmless cancers

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17
Q

How to avoid under treatment of aggressive cancers?

A

Ad-hoc PSA testing !!

18
Q

What does Kllikrein serine protease (prostate-specific protein) do? What is it produced by?

A

Liquifies semen

The prostate glands - may leak into serum

19
Q

What is the normal serum range for PSA?

A

Normal serum range 0-4.0ug/mL

20
Q

How do PSA levels change with age? Give the age-related ranges

A

Increase with age

<50 yrs: 2.5 is upper limit

50-60 yrs: 3.5 is upper limit

60-70 yrs: 4.5 is upper limit

>70 yrs: 6.5 is upper limit

21
Q

Other than BPH and prostate cancer, what else can cause PSA elevations?

A

UTI

Chronic prostatitis

Instrumentation (e.g. catheterisation)

Physiological (e.g. ejaculation)

Recent urological procedure

22
Q

What is the half-life of PSA?

If a repeat PSA is needed, when should recheck be done?

A

2.2 days

Recheck in at least 3 weeks

23
Q

Levels of PSA and cancer probability (PPV):

A

0-1.0: 5%

  1. 0-2.5: 15%
  2. 5–4.0: 25%
  3. 0-10: 40%

>10: 70%

24
Q

How is prostate cancer graded?

A

Gleason Grading

Score 3-5 (well to poorly differetiated)

Then summated to give Gleason SUM score e.g. 3 + 4 = 7 (3 being most common/biggest area; 4 being second most common when looking at cells)

Useful prognostically to determine aggressiveness of cancer - guides treatment

25
Q

What is the gleason sum score now being changed to?

A

ISUP grade group

3+3 = 6 -> 1

3+4 = 7 -> 2

4+3 = 7 -> 3

8 = 4

9 and 10 = 5

(2 is better prognosis than 3 because bigger area of 3)

26
Q

Give the 4 stages that prostate cancer is divided into for treatment and prognosis

A
  • Localised*
  • Locally advanced*
  • Metastatic*
  • Hormone refractory*
27
Q

How is localised prostate cancer staged? (what investigations)

A

Digital rectal examination (local staging)

PSA

Transrectal US guided biopsies

CT (regional and distant staging)

MRI (local staging)

28
Q

Staging of localized prostate cancer by DRE

A

T2b more than 50% of one lobe compared to T2a which is less than 50%

T4 adjacent organs often the bladder or rectum

29
Q

Give the 3 methods for treatment of localised prostate cancer

A
  • Watchful waiting
  • Radiotherapy: external-beam, brachytherapy
  • Radical prostatectomy: open, laparoscopic, robotic

(others under inv = cryotherapy, thermotherapy)

30
Q

Give the 5 methods of treatment for locally advanced prostate cancer

A
  • Watchful waiting
  • Hormone therapy follwoed by surgery
  • Hormone therpay followed by radiation
  • Hormone therapy alone
  • Intermitted hormone therapy (clinical research)
31
Q

Give the 4 types of hormonal therapy for prostate cancer

A
  • Surgical castration (i.e. bilateral orchidectomy)
  • Chemical castration (i.e. LHRH analogue - goserlin, leuprorelin (causes tumour flare in first week - need anti-androgen); or LNRH antagonists) (acts on pituitary stops ADH going to testis to make testosterone)
  • Anti-androgens - inhibits androgen receptors on the testis
  • Oestrogens (i.e. diethylstilboestrol) - inhibits LHRH and testosterone secretion, inactivates androgens and has direct cytotoxic effect on prostatic epithelial cells
32
Q

Give the complications of metastatic and hormone refractory prostate cancer

A
  • Bone: pain, pathological fractures, anaemia, spinal cord compression
  • Rectal: constipation, bowel obstruction
  • Ureteric: obstruction resulting in renal failure
  • Pelvic lymphatic obstruction: lymphoedema, DVT
  • Lower UTI: haematuria, acute retention
33
Q

What is the mainstay of treatment for metastatic and hormone refractory prostate cancer?

A

Immediate hormonal therapy

34
Q

What is the supportive treatment for metastatic and hormone refractory prostate cancer?

A

Palliaitive radiotherapy to bony metastases, colostomy, nephrostomy, zoledronic acid, palliative care support

35
Q

When will hormone refractory stage be reached in metastatic prostate cancer?

A

In 18-24 months of treatment

–Diethylstilboestrol can be tried (high risk of thromboembolic and cardiovascular complications); median response time 4 months

–Docetaxel has survival benefit of 3 months

–Median survival of HRPC stage is 10 months

36
Q

Summary treatment of localised disease

37
Q

Stages and prognosis of prostate cancer

*Urinary System (26 decks)

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