Tumours of the Urinary System (Prostate + Testicular Cancer) Flashcards
What is the commonest cancer diagnosed in men?
Prostate
5 aetiologies/risk factors for prostate cancer?
- 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
Review of McNeal’s prostatic zones
Transition zone
Central zone
Peripheral zone
Anterior fibromuscular stroma
Where does prostate cancer most commonly arise?
Peripheral zone
What do most prostate cancers present as clinically?
Asymptomatic
How is prostate cancer diagnosed?
Through opportunistic PSA testing (not screening!)
What is the diagnostic triad of prostate cancer?
PSA (prostate-specific antigen)
Digital rectal examination
TRUS-guided prostate biopsy
What is PSA?
Prostate-specific antigen
(not necessarily cancer specific!)
Give presenting symptoms of local disease in prostate cancer?
- Weak stream*
- Hesitancy*
- Sensation of incomplete emptying*
- Frequency*
- Urgency*
- Urge incontinence*
- UTI*
Give presenting symptoms of locally invasive disease in prostate cancer?
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
What percentage of newly diagnosed prostate cancers are localised?
80%
Give presenting features of DISTANT METASTASES in prostate cancer
- 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
Give the presenting symptoms of WIDESPREAD METASTASES in prostate cancer
- Lethargy (e.g. due to anaemia, uraemia)
- Weight loss and cachexia
MCQ - what is the commonest mode of presentation for prostate cancer?
Asymptomatic
Why is prostate cancer not screened for?
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
How to avoid under treatment of aggressive cancers?
Ad-hoc PSA testing !!
What does Kllikrein serine protease (prostate-specific protein) do? What is it produced by?
Liquifies semen
The prostate glands - may leak into serum
What is the normal serum range for PSA?
Normal serum range 0-4.0ug/mL
How do PSA levels change with age? Give the age-related ranges
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
Other than BPH and prostate cancer, what else can cause PSA elevations?
UTI
Chronic prostatitis
Instrumentation (e.g. catheterisation)
Physiological (e.g. ejaculation)
Recent urological procedure
What is the half-life of PSA?
If a repeat PSA is needed, when should recheck be done?
2.2 days
Recheck in at least 3 weeks
Levels of PSA and cancer probability (PPV):
0-1.0: 5%
- 0-2.5: 15%
- 5–4.0: 25%
- 0-10: 40%
>10: 70%
How is prostate cancer graded?
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
