8: Prostate and bladder cancer

Question 1

Where is the prostate gland found in relation to the bladder?

Answer 1

Neck of the bladder

Question 2

What part of the urethra is surrounded by the prostate gland?

Answer 2

Prostatic urethra

Question 3

What are zones of the prostate?

Answer 3

Central zone - where benign cancers arise

Peripheral zone - where malignant cancers arise

Question 4

From which zones of the prostate do

a) BPH
b) prostate cancer

develop?

Answer 4

a) Transitional zone

b) Peripheral zones

Question 5

What is the most common cancer found in men in the UK?

Answer 5

Prostate cancer

Question 6

What are the investigations for prostate cancer?

Answer 6

PR exam - hard, full prostate

PSA - blood test, marker for prostate activity

Biopsy

Question 7

Prostate cancers are either well or poorly ___ on biopsy.

Answer 7

differentiated

poorly differentiated is bad

Question 8

What is unique about the appearance of prostate cancer?

Answer 8

Multiple different morphologies can be found in the same cancer

Question 9

Which system is used to grade prostate cancer?

Answer 9

Gleason’s scoring

adding together the two most frequent patterns to get a score out of 10

Question 10

In terms of staging, T1 describes __-__ cancers.

Answer 10

non-palpable

so detected by PSA

Question 11

What is a T2 prostate cancer?

Answer 11

Palpable

Question 12

What is a T3+ prostate cancer?

Answer 12

Found outside the prostate

Question 13

Where does prostate cancer most commonly spread?

Answer 13

Bone

Lymph nodes

Question 14

Metastatic prostate cancer spreads where?

Answer 14

Bones

Lymph nodes

Question 15

What are two investigations used to check for prostate cancer spread?

Answer 15

Bone scan

MRI scan - to see if it has spread outwith the capsule

Question 16

Summarise the investigations for

a) localised
b) metastatic

prostate cancer.

Answer 16

a) PR exam, PSA, biopsy (giving Gleason score)

b) Bone scan, MRI

Question 17

Depending on investigation results, prostate cancer is given a ___ of invasion.

Answer 17

risk

Question 18

How is low-risk, localised prostate cancer managed?

Answer 18

Monitoring

Question 19

How is intermediate to high risk, localised prostate cancer treated?

Answer 19

Prostatectomy - open or laparoscopic

Radiotherapy

Question 20

What is a possible side effect of prostate surgery in men?

Answer 20

Infertility

Question 21

Which hormone stimulates the prostate gland and is suppressed in the treatment of locally advanced disease?

Answer 21

Testosterone

LHRH injections, androgen antagonists

Question 22

Which hormone treatments slow the progression of prostate cancer?

Answer 22

LHRH injections

Anti-androgens

Question 23

Which type of epithelium lines the bladder?

Answer 23

Transitional epithelium, or urothelium

Question 24

What are the risk factors for transitional cell carcinoma?

Answer 24

Age > 40

PMX of renal disease

Smoking - the main one

Exposure to chemicals - dyes, rubber

Analgesic drugs

Chronic UTI - schistosomiasis

Question 25

**TCC** is more common in **(men / women)**.

Answer 25

**men**

Question 26

What is the main presenting complaint of bladder cancer?

Answer 26

**Haematuria**

Question 27

How is **bladder cancer** investigated?

Answer 27

**Cystoscopy** - to view tumours **CT urogram** - to view filling defects

Question 28

What investigation is used to **diagnose** a bladder cancer?

Answer 28

**TURBT** transurethral resection of bladder tumour + **biopsy**

Question 29

How is **bladder cancer** staged?

Answer 29

**TNM staging** based off biopsy

Question 30

Patients with bladder cancer must be monitored for how long?

Answer 30

**Lifelong monitoring**

Question 31

Bladder tumours are classified based on whether or not they've invaded the \_\_\_.

Answer 31

**muscle**

Question 32

Which immunotherapy drug is used to treat **high-risk, non-invasive bladder cancers**?

Answer 32

**BCG** same used in vaccine for TB

Question 33

How is a) low risk b) high risk **non-invasive** bladder cancer managed?

Answer 33

**a) Monitored** **b) BCG vaccine?!??!?!**

Question 34

How is bladder cancer treated if it has invaded the muscle?

Answer 34

**Cystectomy**