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Question 1

Name three main risk factors for prostate cancer

Answer 1

• Age • Family history • Race

Question 2

How is age a risk factor for prostate cancer?

Answer 2

• There is a correlation with increasing age • Uncommon in men younger than 50

Question 3

How is family history a risk factor for prostate cancer?

Answer 3

• 4x increased risk • If one 1st degree relative is diagnosed with prostate cancer before age 60 • After 60 diagnosis probably age related

Question 4

How is prostate cancer related to race?

Answer 4

• Incidence in asian

Question 5

Give the usual presentation of prostate cancer

Answer 5

• Vast majory asymptomatic • Urinary symptoms ○ Benign enlargement of prostate ○ Bladder over activity ○ +/- CaP • Bone pain ○ Advanced metastatic

Question 6

Give an unusual symptom of prostate cancer

Answer 6

haematuria

Question 7

Outline how prostate cancer is diagnosed

Answer 7

• A digital rectal examination • A serum PSA ○ Used to assess wether or not a biopsy in necessary • If it is, carried out via a TransRectal UltraSound guided biopsy of prostate • Lower urinary tract symptoms are treated with a TransUrethral Resection of Prostate

Question 8

Give 5 factors influencing treatment decisions in prostate cancer

Answer 8

MADBP • Age • Digital Rectal Exam • PSA level • Biopsies • MRI scan and bone scan

Question 9

What are the three different results you can get from a digital rectal exam?

Answer 9

• Localised (T1/2) • Locally advances (T3) • Advanced (T4)

Question 10

What can biopsies tell us about the advancement of prostate cancer?

Answer 10

• Gleason grade

Question 11

What is a Gleason grading?

Answer 11

• Pathologist adds together grading score of most common cell type and adds to highest graded prostate tissue

Question 12

Give three treatments for established prostate cancer

Answer 12

• Surveillance ○ Watch cancer, tumor not severe enough to outweigh risks of treatment • Radical prostateectomy Radiotherapy - External beams or low dose brachytherapy

Question 13

Give three treatments for developmental prostate cancers

Answer 13

• High intensity focused ultrasound • Primary cryotherapy - freeze the prostate • Brachytherapy - High dose (small rods implanted in prostate)

Question 14

How can metastatic prostate cancer be treated?

Answer 14

• Hormones ○ Surgical castration, medical castration • PalliationSingle-dose radiotherapy, bisphosphonates, chemotherap

Question 15

Give three ways to treat locally advanced prostate cancer

Answer 15

• Surveillance • Hormones • Hormones & radiotherapy

Question 16

What is haematuria?

Answer 16

• Blood in urine • Classified as visible or non-visible

Question 17

What does it mean if haematuria is visible?

Answer 17

• On investigation there is a 20% chance a malignancy is present

Question 18

What does it mean if haematuria is non-visible?

Answer 18

• Can be symptomatic or asymptomatic Detected via microscopy or urine dipstick

Question 19

Give three causes of haematuria

Answer 19

• Cancer • OtherNephrological

Question 20

Give four types of cancer which can cause haematuria

Answer 20

• Renal cell carcinoma • Upper tract transition cell carcinoma • Bladder cancer • Advanced prostate cancer

Question 21

Give five non-cancerous causes of haematuria

Answer 21

• Stones • Infection • Inflammation • Benign prostatic hyperplasiNephrological

Question 22

What questions must be taken on investigating the history of someone with haematuria?

Answer 22

• Smoking • Occupation • Pain levels • Other UTI symptoms • Family history

Question 23

What should be looked for on examination of someone with haematuria

Answer 23

• BP • Abdominal mass • Varicocele – collection of veins in the scrotum (‘bag of worms’) • Leg swelling • Assess prostate by DRE (male) – Size, texture

Question 24

What investigations should be done for haematuria?

Answer 24

• Urine culture • Cytology • FBC • Ultrasound • Flexible cystoscopy

Question 25

Outline the epidemiology of bladder cancer

Answer 25

• 7th most common cancer in the UK, but incidence decreasing] • Male to female ratio 2.5:1 and 90% are transitional cell carcinomas

Question 26

Give three large risk factors for bladder cancer

Answer 26

• Smoking • Occupational exposure • Schistomiasis

Question 27

How much does smoking increase risk of bladder cancer?

Answer 27

• 4x increased risk

Question 28

Give three examples of occupational exposure increasing risk of bladder cancer

Answer 28

• Rubber or plastics manufacture (arylamines) • Handling of carbon, crude oil, combustion (polyaromatic hydrocarbons) • Painters, mechanics, printers, hairdressers

Question 29

Outline the staging of bladder cancer

Answer 29

• 75% of cancers are superficial • 5% are in situ • 20% are muscle invasive

Question 30

Give three types of bladder cancer which all have different treatments

Answer 30

• High risk non-muscle invasive TCC (transitional cell carcinoma, you simpleton) • Low risk non-muscle invasive TCCMuscle invasive TCC

Question 31

Give two treatments for high risk non-muscle invasive TCC

Answer 31

• Check cystoscopies • Intravesical chemotherapy/immunotherapy

Question 32

Give a treatment for low risk non-muscle invasive TCC

Answer 32

• Check cystoscopies

Question 33

Give two courses of treatment for muscle invasive TCC

Answer 33

• Potentially curative ○ Radical cystectomy or radiotherapy (+/- chemotherapy) ○ Not curative • Palliative chemotherapy/radiotherapy

Question 34

What is a radical cystectomy?

Answer 34

• Removal of the urinary bladder

Question 35

What can be done after a radical cystectomy to simulate a bladder?

Answer 35

• A piece of ileum may be used to make a conduit from the ureters to the abdomen, where urine can be collected in a bag • May also attempt to reconstruct the bladders from a piece of small intestine

Question 36

Outline the epidemiology renal cell carcinoma

Answer 36

• 8th most common cancer in the UK, making up 95% of all upper urinary tract tumours • Male to female ratio of 3:2 and 30% have metastases on presentation

Question 37

Give three risk factors for RCC

Answer 37

• Smoking • Obesity • Dialysis

Question 38

Where does RCC mestatasise to?

Answer 38

• Lymph nodes • Up the renal vein • Vena cava into right atrium • Into subcapsular fat (perinephric spread)

Question 39

What is the established treatment for RCC?

Answer 39

• Surveillance • Radical nephrectomy ○ Removal of kidney, adrenal, surrounding fate and upper ureter • Partial nephrectomy

Question 40

Give a developmental treatment for RCC

Answer 40

• Ablation ○ Removal of tumour via erosive process

Question 41

Give two palliative treatments for RCC

Answer 41

• Molecular therapies targeting angiogenesis • Immunotherapy

Question 42

What is the epidemiology of Upper Tract Transitional Cell Carcinoma (TCC)

Answer 42

• Only 5% of malignancies of URT (Rest are RCC) • 5% due to spread of cancer from bladder • 40% of cancers of the URT spread to bladder

Question 43

Give four investigations for Upper Tract TCC

Answer 43

• Ultrasound • CT urogram • Retrograde pyelogram (inject contrast into ureter) • Ureteroscopy ○ Biopsy ○ Washings for cytology

Question 44

What is the treatment for upper tract TCC?

Answer 44

• Nephro-ureterectomyRemoval of the kidney, fat, ureter and cuff of bladder