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Renal > Prostate and Bladder Cancer > Flashcards

Prostate and Bladder Cancer Flashcards

1
Q

how much does the prostate weight in a young adult?

A

20g

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2
Q

what are the 2 areas of the prostate?

A

apex - inferior portion of prostate, continuous with striated sphincter
base - superior portion and continuous with bladder neck

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3
Q

describe the prostatic urethra

A 
covered by transitional epithelium
contains verumontanum (landmark near the entrance of the ejaculatory ducts (on both sides, corresponding vas deferens and seminal vesicle feed into corresponding ejaculatory duct).)
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4
Q

what are the 3 zones of the prostate?

A

transitional zone
central zone
peripheral zone

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5
Q

describe transitional zone

A

surrounds prostatic urethra proximal to the veru
gives rise to BPH
only 20% of cancers arise here

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6
Q

describe central zone

A

cone shaped region that surrounds the ejaculatory duct

very rare site of cancer

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7
Q

describe peripheral zone

A

posteriolateral prostate
majority of prostatic glandular tissue
70% of prostate cancers arise here

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8
Q

most common cancer in males?

A

prostate

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9
Q

what screening tool is used in prostate cancer/enlargement?

A

PSA (prostate specific antigen)

- not cancer specific, only shows prostate disease/enlargement

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10
Q

risk factors for prostate cancer?

A 
peak age = 70-74 (rare under 50)
more common in the west (rarer in asia)
more common in black males
rare in Asians
family history
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11
Q

presentation of prostate cancer?

A

arises from peripheral zone so usually has no symptoms and is picked up by PSA tests and abnormal PR exam

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12
Q

how might late stage prostate cancer present?

A

lower urinary tract symptoms
haematuria/hematospermia
bone pain, anorexia, weight loss

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13
Q

urinary retention indicates BPH or prostate cancer, why?

A

BPH
BPH arises in transitional zone so causes urinary symptoms
cancer arises in peripheral zone so doesn’t really affect urinary tract

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14
Q

what is PSA?

A

prostatic specific antigen
glycoprotein enzyme produced by secretory epithelial cells of prostate gland
involved with liquefaction of semen

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15
Q

describe PSA levels in health

A

high semen levels
low serum levels
- serum levels increase in cancer

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16
Q

what is done if raised PSA is found?

A

trans rectal US guised prostate biopsy (TRUS biopsy)
US probe passed through rectum and prostate visualised in transverse and sagittal section
10 biopsies taken (5 from each lobe - as prostate cancer is multifocal)

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17
Q

risks of TRUS biopsy?

A

infection
bleeding
fainting
haematospermia and haematuria for 2-3 weeks

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18
Q

describe features of most prostate cancers

A

most are multifocal adenocarcinomas
growth starts with local extension through capsule, into urethra, bladder, seminal vesicles etc and then perineural invasion along autonomic nerves
sclerotic lesions are characteristic

19
Q

common sites for metastases in prostate cancer?

A

pelvic lymph nodes

skeleton

20
Q

how is prostate cancer graded?

A 
gleasons system (based on architectural appearance)
stages 1-5
score increases with loss of glandular structure and replacement by a disorganised malignant growth pattern
21
Q

how is prostate cancer staged?

A 
TNM
T = primary tumour 
- T1 = not palpable or visible by imaging
T2 = tumour confined within prostate
T3 = tumour extends through prostate capsule
T4 = tumour fixed or invades adjacent  structures other than seminal vesicle, bladder neck, external sphincter, rectum, levator muscles or pelvic wall
N = regional lymph nodes
N0 = no regional lymph nodes metastasis
N1 = regional lymph node metastases
M = distant metastases
M0 = no distant metastasis
M1 = distant metastasis
22
Q

how is prostate cancer imaged?

A

bone scan
MRI
CT scan

23
Q

3 broad categories of prostate cancer?

A 
organ confined
- T1-2, N0, M0
locally advanced
- T3-4, N0, M0
metastatic disease
- N+, M+
24
Q

how is organ defined disease managed?

A

watch and wait/deferred treatment/symptoms management
active surveillance/monitoring (treat at pre-defined thresholds that classify progression, curative intent)
radical surgery
radical radiotherapy

25
Q

management of locally advanced disease?

A 
radiotherapy with neo-adjuvant therapy
watchful waiting (in asymptomatic palliative patients)
hormonal therapy (for symptom management in palliative patients)
26
Q

how is metastatic disease managed?

A 
androgen deprivation
- hormonal therapy (LHRH analogues, anti-androgens)
- orchidectomy
- max androgen blockade
diethylstilbesterol/steroids
cytotoxic chemotherapy
27
Q

growth of prostate cancer cells is under control of what 2 hormones?

A

testosterone
dihydrotestosterone
testosterone exerts a negative feedback control on hypothalamic LH secretion, if prostate cells are deprived of androgenic stimulation, they undergo apoptosis

28
Q

where does testosterone come from and what regulates its secretion?

A

90% from testes
10% from adrenals
regulated by hypothalamic-pituitary-gonadal axis

29
Q

how can androgen agonist therapy be used in control of prostate?

A

chronic exposure to LHRH agonists results in f=down-regulation of LHRH receptors, with subsequent suppression of pituitary LH and FAH secretion and testosterone production

30
Q

side effects of LHRH agonists?

A 
initially causes a surge in LH and FSH and therefore testosterone as the initially stimulate LHRH receptors
- can cause spinal cord compression
- prevented with use of anti-androgens
loss of libido
ED
hot flushes/sweats
weight gain
gynaecomastia
anaemia
cognitive changes
osteoporosis
31
Q

how can anti-androgens be used to control prostate?

A

they compete with testosterone and DHT for binding sites on their receptors in prostate cell nucleus, promoting apoptosis

32
Q

what are the types of anti-androgens?

A

steroidal (cyproterone acetate)
- causes loss of libido, ED, gynaecomastia, cardio toxicity and hepatotoxicity
non-steroidal
- sexual intrest/libido maintained
- causes gynaecomastia, breast pain and hot flashes, hepatotoxicity

33
Q

how is bladder cancer diagnosed?

A

clinical symptoms
CT contrast scan
- MRI if contrast allergic
urethroscope (cystoscopy)

34
Q

types of cancers in bladder?

A

90% are transitional cell
9% are squamous cell
1% (adeno, sarcoma etc)

35
Q

classification of transitional cell carcinoma?

A

papillary (80% - only 50% are infiltrative malignancies)

non-papillary (20% - all are considered malignant)

36
Q

2 types of papillary carcinoma?

A

papilloma (growing outwards, pedunculated)

invasive = growing deep into structure

37
Q

2 types of flat carcinoma?

A

invasive

non-invasive

38
Q

how are uroepithelial tumours imaged?

A 
excretory urogram
sonography
retrograde pyelogram
computed tomography
angiography
39
Q

how may a transitional cell tumour appear on imaging?

A

single lesion (can be small and papillary or bulky and sessile)
multiple discrete lesions
diffuse and confluent lesions

40
Q

describe transitional cell carcinoma

A

tend to be multicenteric and bilateral

41
Q

who is bladder cancer more common in?

A

males

after 5th decade of life

42
Q

main diagnostic tool for bladder carcinoma?

A

CT urography

cystography

43
Q

common metastases for bladder cancer?

A

lymph nodes

Renal (34 decks)

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