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RENAL > Prostate & Bladder Cancer > Flashcards

Prostate & Bladder Cancer Flashcards

1
Q

Where is the base of the prostate located?

A

Next to the bladder

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2
Q

Where is the apex of the bladder located?

A

Inferior part of prostate

continuous with striated sphincter

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3
Q

What type of epithelium covers the prostatic urethra

A

transitional epithelium

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4
Q

What are the 3 main zones of the prostate?

A

Transitional zone
Central zone
Peripheral zone

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5
Q

In what zone do most adenocarcinomas of the prostate occur?

A

Peripheral zone

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6
Q

Which zone of the prostate is responsible for BPH?

A

Transitional

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7
Q

Many patients may die from other causes rather than causes directly attributable to prostate cancer. TRUE/FALSE?

A

TRUE

other comorbidities usually are responsible for the death rather than the cancer

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8
Q

When is the peak incidence of prostatic cancer?

A

Peak age-70-74 years

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9
Q

The majority of prostate cancers are asymptomatic. TRUE/FALSE?

A

TRUE

Picked up by PSA tests and abnormal DRE findings

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10
Q

If patients with prostatic cancer do present with symptoms, what do they commonly present with?

A
  • Lower urinary tract symptoms
  • Haematuria
  • Bone pain, Anorexia, Weight loss
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11
Q

What features indicate an abnormal finding on a Digital Rectal Examination?

A
  • Asymmetry
  • Nodule
  • Fixed craggy mass
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12
Q

Prostate specific antigen has a high specificity for prostate cancer. TRUE/FALSE?

A 
FALSE
Many other things can cause raised PSA
BPH
Prostatitis / UTI’s
Retention
Catheter
DRE
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13
Q

An abnormal DRE and elevated PSA indicates what type of biopsy must be carried out?

A

Trans-Rectal Ultrasound guided Prostate Biopsy

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14
Q

How many biopsies are taken during a trans-rectal US prostate biopsy and why?

A

10 biopsies taken
( 5 from each lobe )
Many prostate cancers are multifocal => in multiple places on the prostate

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15
Q

What do trans-rectal US prostate biopsies carry a sepsis risk?

A

Potential to take bacteria from rectum through the wall to the prostate

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16
Q

Describe the normal pattern of local tumour growth in prostate cancer?

A 
prostatic capsule
urethra
bladder base 
seminal vesicals 
Perineural invasion along autonomic nerves
17
Q

How are prostate cancers graded?

A

Gleason’s Scoring
Microscopically graded from 1 to 5
Two most abundant cell patterns are assessed then added together to give a score between 2 to 10

18
Q

What are the 3 broad classifications of prostate cancer?

A

Organ-Confined disease
T1-2 N0 M0

Locally advanced Disease
T3-4 N0 M0

Metastatic Disease
N+, M+

19
Q

How is organ confined prostate cancer usually treated?

A

Watchful waiting
Active surveillance
Radical surgery
Radical radiotherapy

20
Q

How is locally advanced disease normally treated?

A

Radiotherapy with neo-adjuvant hormonal therapy

If not suitable for curative Tx, they can be given hormonal therapy on its own to help symptoms

21
Q

How is metastatic prostate cancer usually treated?

A

Androgen Deprivation therapy
Diethylstilbesterol (oestrogen)
Steroids
Cytotoxic chemotherapy

22
Q

What hormones are known to stimulate the growth of prostatic cancer cells?

A

testosterone and dihydrotestosterone

23
Q

How can we ensure prostate cells undergo apoptosis?

A

Deprive them of androgenic stimulation

24
Q

What is the aim of LNRH agonists?

A

eventually down-regulates LHRH-receptors

=> suppress LH and FSH secretion and testosterone production

25
Q

Why should you cover 1 week before and 2 weeks after the first dose of LHRH injection with an anti-androgen?

A

In this time the LNRH can cause a small rise in FSH,LH and testosterone
=> having a negative effect

26
Q

What is the function of anti-androgens?

A

Compete with testosterone and DHT
- binding site = on receptors in prostate cell nucleus
=> apoptosis and inhibiting cancer growth

27
Q

What are the two types of anti-androgens?

A

Steroidal (cyproterone acetate)

Non-steroidal (nilutamide, flutamide and bicalutamide)

28
Q

Most bladder cancers arise from what type of epithelium?

A

Transitional/urothelium (90%)

Squamous (9%)

29
Q

What are the two main types of transitional epithelium cancer?

A

Papillary (around 50% malignant)

Non-papillary (All considered malignant)

30
Q

How can transitional epithelium tumours be imaged?

A 
Excretory urogram
Sonography
Retrograde pyelogram
CT
Angiography
31
Q

What is a bladder halo sign?

A

A filling defect associated with bladder cancer which is highlighted by contrast

32
Q

What is the first procedural investigation you would use for bladder cancer?

A

Cystoscopy

RENAL (24 decks)

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