Genitourinary Conditions

Question 1

The most common cause of cancer in AU men is…

Answer 1

Prostate cancer

Question 2

Three kinds (incl which is most common) of prostate cancer

Answer 2

1. Adenocarcinoma (most common)
2. Urothelioma
3. Squamous cell carcinoma

Question 3

Risk factors for prostate cancer

Answer 3

• Old age
• FHx
• Genetic mutations (e.g. BRCA2)
• African american ethnicity

Question 4

What are the screening tests for prostate cancer?

Answer 4

1. Digital Rectal Exam (NOT recommended though)
2. Prostate Specific Antigen (PSA)

Question 5

Clinical Fx of prostate cancer (early, local, metastatic)

Answer 5

• Early: asymptomatic
• Local: obstructive UT symptoms (difficulty voiding, urgency), blood in urine or semen
• Met: bone pain, weight loss, fatigue

Question 6

Prostate cancer diagnostic Ix

Answer 6

• Biopsy (guided by transrectal ultrasound)
• MRI

Question 7

How does prostate cancer gleason scoring work?

Answer 7

• Score 2 most common cell populations for differentiation from 1 to 5 (5 is more different/cancerous)
• Add up both scores (6-10 is cancer; report more populous first out of the two numbers)

Question 8

Treatment approaches to prostate cancer

Answer 8

• Watchful waiting (monitor PSA at lengthening intervals; send to urologist if PSA increases)
• Active surveillance (PSA testing + MRI/biopsy and DRE); tries to avoid adverse treatment effects
• Surgery (radical prostatectomy)

Question 9

What are some complications of radical prostatectomy?

Answer 9

• Erectile dysfunction
• Incontinence (why?)
• Ejaculation changes (which ones?)
• Infertility (why?)

Question 10

Describe indications/use cases for external beam radiotherapy in prostate cancer

Answer 10

• Localised cancer/limited bone metastases
• Recurrence w./ no mets following surgery
• Can be used to reduce tumour, but also as pain relief

Question 11

What is brachytherapy? When can it be used in prostate cancer?

Answer 11

• (Brachy = small); small radioactive seeds into prostate
• For patients w/ mild prostate cancer that don’t want full surgery

Question 12

Complications of prostate radiotherapy

Answer 12

• Fatigue
• Erectile dysfunction
• Difficulty urination causing urgency
• Changes to bowels (over long term)

Question 13

Specific Rx for advanced metastatic prostate cancer

Answer 13

• Androgen deprivation therapy (GnRH agonists OR antagonists achieve this; how?)
• RANK ligand inhibitors (why?)

Question 14

Where are the transition zone and the peripheral zone of the prostate, roughly speaking, and where is cancer vs BPH more common?

Answer 14

• Transition zone is anterior (change = forward thinking); BPH is more common here
• Peripheral zone is posterior; cancer is more common here (older ideas become malignant - culture becomes corrupt)

Question 15

How does diffusion MRI help identify cancer? Is this the same as multiparametric MRI?

Answer 15

• DIffusion measure how freely water can move in tissue
• In cancer, cells are tightly packed, so lower movement
• Areas of lower movement can therefore indicate cancer
• Not the same as multiparametric; this instead uses multiple MRI sequences, including (but not limited to) diffusion

Question 16

What is PIRADS? How does scoring work?

Answer 16

• Prostate Imaging Reporting and Data System
• Criteria for imaging gives rise to scoring system; 1 = unlikely and 5 = highly likely cancer

Question 17

How does PSMA PET work?

Answer 17

• Prostate specific membrane antigen binds to prostate w/ radioactive marker -> gets picked up on scan
• Helps to detect nodes and mets that are involved

Question 18

Two main classifications of testicular cancer (plus details)

Answer 18

• Germ cell tumours (seminoma vs non-seminoma)
• Sex cord stromal tumours
• Non-specific stromal tumours

Question 19

Risk factors for testicular cancer

Answer 19

• Personal/Fhx
• Cryptorchidism

Question 20

Inspection on male genitalia exam

Answer 20

• Penis/groin/abdo (skin changes, scars, masses)
• Scrotum/perineum (warts, bruising, masses, swelling)

Question 21

Palpation on male genitalia exam

Answer 21

• Penis: retract foreskin (inspect for abnormalities)
• Testicles (palpate between two fingers for size and consistency, epididymis/spermatic cord, prehn’s test, cremasteric reflex)

Question 22

Diagnostic workup for testicular lump

Answer 22

• Ultrasound (NO BIOPSY)
• Consider CT abdo, pelvis, chest
• Tumour markers (alpha fetoprotein, LDH, hCG)

Question 23

Differentials for testicular lump (other than cancer)

Answer 23

• Epididymal cysts (feel separate from teste on palpation)
• Spermatocele (fluid filled cyst containing sperm; attache to testis)
• Hydatid of morgagni (appendix testis torsion)
• Hydrocele (fluid-filled)

Question 24

Things to assess a scrotal mass for

Answer 24

• Size, site shape
• Tenderness, consistency
• Transillumination (light through = fluid; not - solid)

Question 25

Management of testicular cancer

Answer 25

- Orchidectomy (tunica albuginea and spermatic cord also released) - Adjuvant chemo/radiotherapy - Psychological support (?professional help) - Fertility (consider freezing sperm)