Flashcards in Bladder and Prostate cancer Deck (24):
What kind of epithelium lines the prostatic urethra?
What do the ejaculatory ducts unite?
Seminal vesicles and the vas deferens
Where do most prostate cancers arise from?
The peripheral zone
What kind of cancer arises from the peripheral zone of the prostate?
What kind of bony metastases do you get in prostate cancer?
What is the scoring system used form prostate cancers?
What is the initial feature described by gleason scoring?
Loss of basement membrane
Explain briefly how gleason scoring works?
The architectural scoring is graded from 1 to 5 based how how disorganised it is. he two most abundant patterns are then added together to give a score between 2 and 1.
Give for options for the treatment of organ defined prosatate cancer?
Give three options for the treatment for locally advanced prosate cancer
Radiotherapy + hormonal therapy
Watchful waiting (patients with well differentiated tumours and a life expectancy of less than 10 years.
Hormonal therapy (symptomatic patients who are unfit for radical treatment)
What two hormonal therapies are used in metastatic disease?
How do LNRH analogues work?
LNRH agonists eventually result in the down regulation of LNRH receptors with subsequent suppression of pituitary LH and FSH secretion and testosterone production.
LNRH analogues initially stimulate pituitary LNRH receptors and cause a transient rise in LH and FSH release and so elevate testosterone production.
What is the risk with starting an LNRH analogue?
The transient rise in testosterone production can cause catastrophic spinal cord compression
How to you reduce the risk of catastrophic spinal cord compression when starting an LNRH analogue?
Anti androgen cover 1 week before and two weeks after the first LNRH injection.
Give an example of an anti androgen steroidal medication
How to anti androgen drugs work?
Compete with testosterone and dihydrotestosterone for binding sites on their receptors in the prostate cell nucelus
Give an example of an anti androgen that maintains libido and sexual interest
Non steroidal such as nilutamide and flutamide
What are the main side effects of steroidal anti androgen drugs?
Loss of libido and erectile dysfunction
What is the main side effect on non steroidal anti androgen drugs?
Gynaecomastia, breast pain
What is sterile pyuria?
presence of elevated numbers of white cells in urine which appears sterile using standard culture techniques.
A 65 year old man is found to have sterile pyuria and symptoms of cystisis.
Bladder cancer until proven otherwise
A 67 year old retired jute mill worked presents with haematuria. What investigation do you order?
IV urogram and cystoscopy
What is the most common type of bladder cancer?