Wk 6 Prostate Cancer

Question 1

4 risk factors for prostate cancer

Answer 1

1. Age: 90% are in men over age 50 - strongest risk factor
2. Family Hx
3. Race - more common in African-American men
4. BCRA mutation carriers

Question 2

What is PSA

Answer 2

=prostate specific antigen
- a glycoprotein (KLK3) expressed by normal and neoplastic prostate tissue
- fxns as a serine protease to: 1. liquify semen 2. dissolve cervical mucus
- exists in serum in free and bound forms, so total = free PSA + complexed PSA
- can be elevated by a number of things, want to look a changes over time

Question 3

What can lead to elevated PSA

Answer 3

1. protatitis
2. prostate exam
3. prostate biopsy

Question 4

What determine prognosis of cancer?

Answer 4

1. PSA level
2. clinical stage (digital rectal exam)
3. biopsy (Gleason score)

Question 5

What determines if tx will happen with prostate cancer?

Answer 5

NCCN PCa risk stratification

Question 6

How is localized prostate cancer treated?

Answer 6

Curative:
1. radical prostatectomy
2. radiation therapy (similar outcomes)
OR
3. active surveillance

Question 7

Side effects of prostate Ca tx (surgery and/or radiation)

Answer 7

1. urinary incontinence
2. erectile dysfunction

Question 8

Where is BPH often seen in the prostate?

Answer 8

middle of prostate

Question 9

Clinical presentation of BPH

Answer 9

urinary retetion
UTI

Question 10

Clinical presentation of BPH

Answer 10

urinary retetion
UTI

Question 11

TX of BPH

Answer 11

TERP - cut out tissue to widen urethra

Question 12

How do BPH and prostate cancer compare histologically?

Answer 12

Lower right = cancer - crowded, no basal cell layer (only single cell lining), enlarged nuclei, clonal, losing polarity (moving away from basal layer)

Question 13

What is Gleason’s Pattern?

Answer 13

A way to score the cancer
-add 2 scores of highest proportions
-indicates how aggressive the cancer is

Question 14

What does inasive indicate?

Answer 14

The cancer has spread to the submucosa

Question 15

What does inasive indicate?

Answer 15

The cancer has spread to the submucosa

Question 16

How do NSAIDs influence adenoma development?

Answer 16

Inhibit COX and therefore prostaglandins

Question 17

Adenoma

Answer 17

precursor and potential for cancer

Question 17

Adenoma

Answer 17

precursor and potential for cancer

Question 18

Sessile serrated adenoma

Answer 18

Question 19

Tubular adenoma

Answer 19

low grade dysplasia
surface epithelium

Question 20

invasive adenocarcinoma

Answer 20

Question 21

Juvenile polyposis syndrome

Answer 21

Question 22

JPS

Answer 22

-at risk for colon cancer, gastric and small intestine adenocarcinoma

Question 23

Genetics of juvenile polyposis syndrome

Answer 23

autosomal dominant
-SMAD4 mutation

Question 24

Cancer potential w/ juvenile polyps

Answer 24

Only JPS has potential for cancer
sporadic juvenile polyps do not

Question 25

Peutz-Jeghers poylps

Answer 25

-marker for increased risk of cancer in colon, breast, stomach, sm intestine and more

Question 26

Peutz-Jeghers Syndrome

Question 27

PTEN hamartoma-tumor syndrome

Answer 27

autosomal dominant
-mutation in PTEN TS gene
-high risk of melanoma, thyroid, breast, colon cancers
-trichilemmomas (small bumps on nose)
-lipomas
-macrocephaly
-freckling on penis

Question 28

Cronkhite-Canada syndrome

Answer 28

-unknown cause
-hamartomatous polyps
-nail atrophy, alopecia, skin hyperpigmentation, diarrhea, cachexia, anemia
-in intervening tissue as well
-rare, fatal in 50%

Question 29

Tuberous Sclerosis

Answer 29

mutations in TSC1 and TSC2
-presents soon after birth
-epilepsy, cortical tubers, astrocytomas
-cortical tubers