11/20- Malignant Diseases of the GU system Flashcards Preview

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Flashcards in 11/20- Malignant Diseases of the GU system Deck (82)
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1

What is the most common urologic malignancies? Next?

1. Prostate

2. Bladder

3. Kidney

4. Testis

2

Among men, ___ cancer is the most common.

This cancer is the #__ cause of cancer deaths in men

Among men, prostate cancer is the most common.

This cancer is the #2 cause of cancer deaths in men (2nd to lung)

3

Bladder is the #__ most common and the #__ cause of cancer deaths (among men)

Bladder is the #4 most common and the #8 cause of cancer deaths (among men)

4

T/F: There is no GU cancer in the top 10 causes of cancer in women. What is the highest?

- True; no GU cancer in top 10 women cancer cases

- Kidney cancer is #8 (only 3% of new cases)

5

What are the risk factors for Prostate cancer?

- Which is most important

- What are modifiable risk factors

- Advanced age

- African American race (more common and earlier age/higher stage)

- Family history (strongest!)

- Modifiable risk factors

  • Obesity
  • Fat intake (mono-unsaturated fats)

6

Describe family history role in prostate cancer/risks

- 2-3x increased risk of prostate cancer

- BRCA link: female relatives with breast/ovarian cancer

7

What is involved in prostate cancer screening?

- PSA: prostate-specific antigen

- DRE: digital rectal exam

  • Palpation of posterior zone of prostate
  •  Should be done annually for men > 50 yo BOTH are required

8

What is PSA? - What is it's function? - Circulation

Serine protease that is unique to prostate

- Lyses seminal coagulum

- Circulates free or bound to a-1 antichymotrypsin

- %free correlates with benign vs. malignant

  • >25%: more likely BPH
  • < 10%: at least 50% chance of being cancer
  • Only valid at total PSA values 4-10

9

Describe the expected values/diagnostic criteria levels of PSA

% free correlates with benign vs. malignant

- >25%: more likely BPH

- <10%: at least 50% chance of being cancer

- Only valid at total PSA values 4-10

10

__% of prostate cancer occurs in the ____ zone

75% of prostate cancer occurs in the posterior zone

- Habitus may make difficult; technical points

- PSA testing has caused "stage migration" (finding earlier)

11

What has US Preventive Services Task Force (USPSTF) recommends what for prostate screening?

What does American Urological Association say?

- Recommends against prostate specific antigen (PSA)-based screening for prostate cancer

- American Urological Association disagrees: all men 55-69 yo should discuss PSA screening with provider and get screened every 2 yrs

  • Little benefit to men 70+ with life expectancy under 10-15 yrs
  • Screening with PSA has reduced prostate cancer mortality
  • Screening with PSA has led to diagnosis and treatment of many indolent cancers

12

What is the sensitivity and specificity of PSA screening?

How to improve?

Overall

- Sensitivity: 35%

- Specificity: 63%

If stratify for PSA > 4:

- Sensitivity: 86%

- Specificity: 33%

13

How should we manage screening of prostate cancer?

Need to focus on age-specific! recommendations and practices (and tx need to maximize cure and minimize ASEs)

14

How is prostate cancer diagnosed?

- What is the most common stage?

- Transrectal US-guided prostate biopsy

- Histologic report: Gleason grading

- DRE >> clinical stage

  • Most common = T1c

- Risk stratification

Biopsy features + DRE = grade and stage then:

- Staging: imaging in intermediate/high risk

  • Bone scan and CT of abdomen/pelvis

15

Describe the staging of prostate cancer

- T1a, T1b by TURP

- T1c: non-palpable

- T2: palpable but organ confined

- T3a: extra-capsular

- T3b: SV invasion

- T4: invades adjacent organs

16

What is the median age of diagnosis of prostate cancer?

- Most common stage

- Peak when and why

- Median age of Dx: 66 yo

- Most in cT1c stage (localized): 60-75%

- Peak in 1992 due to PSA use

17

How are prostate cancer deaths changing?

Prostate cancer deaths are decreasing

- PSA finding cancer earlier

- Better treatments

18

What is the 5 year survival of prostate cancer:

- Localized

- Regional

- Distant

- All stages

Natural history of prostate cancer is very long:

- Localized: 100%

- Regional: 100%

- Distant: 28%

- All stages: 99%

19

What is management/treatment of prostate cancer?

Active surveillance

- Risk features

- Protocol for monitoring

Surgery

- Radical prostatectomy + bilateral pelvic LND

- Approaches and risks

Radiation

- External beam therapy

- Brachytherapy: radioactive seeds

Investigational

- Focal therapies

20

Describe TMN staging of organ-confined prostate cancer

Organ-confined: not though to involve regional LN or any visceral organs

- Clinical stage: cT1-3, N0, M0

21

Surgery is therapeutic and diagnostic for treating prostate cancer. What does it involve?

- Excision of prostate, seminal vesicles

- Excision of pelvic LNs

- Anastomosis of bladder to urethra

- Pathologic analysis > prognostic information

22

Describe TMN staging of advanced stage prostate cancer

- Locally advanced stage: cT4

- Nodal metastasis: N1

- Distant metastasis: M1

This scan shows something at femoral head (not kidneys, those normally light up), and actually has a lot of vertebral mets

23

What is treatment for advanced stage prostate cancer treatment?

Systemic treatment

- Androgen deprivation (ADT)

- Chemotherapy

- Other hormonal tx

Role for local therapy (Surgery, XRT) must be individualized

24

What are surgical and pharmacologic methods of androgen deprivation?

Surgical: orchiectomy

Pharmacologic:

- LHRH agonists: Lupron, Zoladex, Eligard

- Anti-androgens: Bicalutamide, Flutamide

- Older but occasionally utilized:

  • Ketoconazole
  • Diethylstilbesterol

25

SUMMARY of prostate cancer

- Screening

- Staging

- Treatment

Screening

- PSA and stage migration

- Long survival and low mortality make use of PSA controversial

Staging

- Overwhelming majority low-stage

- Most common stage

Treatment

- Risk stratified

26

Testis cancer is a ___ ___ tumor

Testis cancer is a germ cell tumor

27

What is seen here?

Testis cancer

28

Describe epidemiology of testis cancer:

- Most common malignancy in what population

- __% of all cancers in men worldwide

- Age of distribution is ____

- Ethnicity

- Most common malignancy in young men (15-34 yo)

- 1% of all cancers in men worldwide

- Age of distribution is bimodal

- Whites 5-6x more than blacks

29

What are risk factors for testis cancer?

- Undescended testicle (even if brought down)

- Maternal estrogen exposure

- Contralateral testis tumor

30

25% of men with testis cancer will present how? (important)

Subfertile semen parameters (in 25% of men with testis cancer)