Prostate and bladder cancer Flashcards Preview

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Flashcards in Prostate and bladder cancer Deck (82):
1

What is the apex of the prostate?

Inferior pole (continuous with striated sphincter)

2

What is the base of the prostate?

Superior pole (continuous with bladder neck)

3

What type of epithelium composes the prostatic urethra?

Transitional

4

What is the vermontanum (seminal colliculus)?

Part of urethra distal to urethral angulation where the ejaculatory ducts drain

5

What are the ejaculatory ducts?

Joint vas deferans and seminal vesicles

6

What are the zones of the prostate?

Transitional
Central
Peripheral

7

Where is the transitional zone of the prostate

Surrounds prostatic distal to vermontanum

8

What common pathologies arise from the transitional zone of the prostate?

Prostate cancer (10-20%)
Benign prostatic hyperplasia

9

Where is the central zone of the prostate?

Cone shaped region that surrounds the ejaculatory ducts

10

What pathology arises from the central zone of the prostate?

Prostate cancer (very rarely)

11

Where is the peripheral zone of the prostate?

Posterolateral

12

Which zone of the prostate is the biggest?

Peripheral zone (composes most of the tissue)

13

What pathology arises from the peripheral zone of the prostate?

Prostatic adenocarcinoma (majority)

14

The prostate has fibromuscular stroma which for some reason isn't listed as one of the zones thank fuck for podcast lectures am i right. T/F

True - cannot be palpated on examination as it is anterior

15

What is the most common malignancy affecting males in the UK?

Prostate

16

Is mortality high in relation to prostate cancer?

Yes

17

Which screening test is used to detect prostate cancer?

Prostate specific antigen

18

What is the natural history of prostate cancer?

Long, indolent course

19

What are the risk factors associated with prostatic cancer?

Age (>50)
Western world
Black men
Family history

20

How does prostatic cancer present?

Majority asymptomatic
Lower urinary tract symptoms
Haematuria
Haematospermia
Bone pain (night)
Anorexia
Weight loss

21

How is asymptomatic prostate cancer picked up?

Prostate specific antigen
Digital rectal exam

22

How does prostate cancer present on rectal exam?

Asymmetry
Nodule
Fixed craggy mass

23

By the time prostate cancer is picked up most patients will have metastases. T/F

True

24

What is prostate specific antigen?

Glycoprotein enzyme

25

What produces prostate specific antigen?

Secretory epithelium of prostate

26

What does prostate specific antigen do?

`Help liquify semen

27

How will prostate specific antigen levels differ between normal and cancerous prostates?

Normal - high semen low serum
Cancerous - high semen high serum

28

What is the specificity and sensitivity of prostate specific antigen?

Specificity - low
Sensitivity - high

29

Which conditions elevate prostate specific antigen levels?

Benign prostatic hyperplasia
Prostatitis
UTI
Retention
Catheterisation
Digital rectal exam

30

When is PSA testing indicated?

Symptomatic patients
Asymptomatic patients who've underwent counselling

31

Why is counselling mandatory prior to PSA in asymptomatic patients?

Cancer rates are very low and treatment/investigations can be associated with morbidity and lowered QoL

32

What is a TRUS biopsy? Is uncomfortable?

Trans rectal USS + biopsy
Honestly what do you think

33

What are the indications of a trans rectal US guided biopsy?

Abnormal rectal exam + raised PSA
Previous abnormal biopsy
Previous normal biopsy but with raised PSA

34

What are PIN and ASAP prostate biopsy results?

Prostatic intraepitherlial neoplasia
Atypical small acinar proliferation

35

How many biopsies are taken in a TRUS biopsy?

5 from each lobe of the prostate (i.e 10)

36

What are the complications of a TRUS biopsy?

Rectal bleeding
Haematuria/haemospermia for 2-3 week post procedure
Sepsis
Vaso-vagal fainting

37

The majority of prostate cancers are what?

Multifocal adenocarcinomas

38

How does adenocarcinoma tend to spread locally?

Prostate capsule
Urethra
Bladder base
Seminal vesicles
Autonomic nerves

39

Where does prostate cancer commonly metastasis to?

Bones
Pelvic lymph nodes

40

What type of bone metastases is present in prostatic cancer?

Osteosclerotic

41

How is prostatic cancer graded? Describe this system

Gleason's score
Based on architectural appearance of prostate gland
- Initial feature of malignancy is loss of basement membrane -->
- Progressive loss of glandular structure and replacement by malignant growth -->
- Abundant cell patterns assessed then added to give score

42

Describe the TNM classification

T
- 1 clinically inapparent
- 2 confined to prostate
- 3 extension through capsule
- 4 local spread
N
- 0 no nodes
- 1 regional nodes
M
- 0 no distant metastases
- 1 distant metastases

43

How is prostatic cancer staged?

Bone scan
MRI
CT

44

What are the broad classifications of prostate cancer spread?

Organ confined
Local spread
Metastatic

45

Which factors influence management of prostate disease?

Category of disease
Patient wishes/quality of life
Life expectancy
Co-morbidities
Age

46

How is organ confined prostate cancer managed?

Watchful waiting/symptom guided (conservative > palliative)
Active monitoring
Radical surgery (prostatectomy)
Radical radiotherapy (EBRT, brachytherapy)

47

What are the complications of prostatectomy?

Erectile dysfunction
Incontinence
Bladder neck stenosis

48

What are the complications of radical radiotherapy?

Irritative lower urinary tract symptoms
Haematuira
GI symptoms
Erectile dysfunction
Incontinence

49

How is locally advanced prostate disease managed?

Radiotherapy with neo-adjuvant hormonal
Watchful waiting
Hormonal therapy

50

Where is watchful waiting indicated in locally advanced prostate cancer?

Patient refuses treatment
Asymptomatic and well differentiated tumour with

51

When is hormonal therapy indicated in locally advanced prostate cancer?

Symptomatic with need for palliation of symptoms but with no/low change of cure

52

How is metastatic prostate cancer managed?

Androgen deprivation therapy
Diethylstilbesterol/steroids
Cytotoxic chemotherapy

53

List the types of androgen deprivation therapy

Hormone therapy (LHRH analogues, anti-androgens)
Bilateral subcapsular orchidectomy
Maximal androgen blockade

54

Which hormones influence growth of prostate cancer?

Testosterone
Dihydrotestosterone

55

Where do hormones influencing the growth of prostate cancer come form?

Adrenal
Testis

56

Testosterone induces negative feedback how?

Reduces hypothalamic LH secretion (i.e reduces LHRH)

57

What happens if prostate cells are not stimulated by androgens?

Undergo apoptosis

58

How do LHRH agonists work?

Down regulation of LHRH receptors and thus reduced secretion of FSH and LH --> reduced testosterone

59

What is testosterone surge in relation to LHRH agonists?

Initially cause an increase in LHRH and thus FSH and LH hence increased testosterone

60

What is the major serious complication of LHRH agonists? How can this be prevented?

Catastrophic spinal cord compression
Anti-androgens give one week prior and two weeks post first dose of LHRH agonists

61

What are the side effects of LHRH agonists?

Erectile dysfuction +/- loss of libido
Weight loss
Gynecomastia
Cognitive change
Osteoporosis
Anaemia
Hot flushes/sweats

62

How do anti-androgens work?

Compete with testosterone and dyhydrotestosterone for their binding sites within to prostate cell nucleus --> promotes apoptosis and inhibits cancer growth

63

What are the two types of anti androgens?

Steroidal (cyproterone acetate)
Non-steroidal (nilutamide, flutamide, bicalutamide)

64

What are the side effects of steroidal anti-androgens?

Loss of libido
Erectile dysfunction
Gynecomastia (rare)
CVS toxicity
Hepatotoxicity

65

What are the side effects of non-steroidal anti-androgens?

Gynecomastia
Breast pain
Hot flashes
Hepatotoxicity

66

Do males or females more commonly get bladder cancer?

Males

67

Bladder cancer needs lifelong monitoring +/- treatment. T/F

True

68

Bladder cancer is highest in the western world. T/F

True

69

How might bladder cancer be diagnosed?

KUB x-ray (IV pyelogram)
USS
Retrograde pyelogram (if kidney damage)
Cytoscopy (this)
CT (this)
Angiography

70

Are transitional cell or squamous cell carcinomas more common in the bladder?

Transitional cell (by a large margin)

71

How can transitional cell bladder cancer be categorised? Which is more common

Papillary (common)
Non-papillary

72

All transitional cell bladder cancers are infiltrative. T/F

False - some papillary cancers are not invasive malignancies but all non-papillary ones are

73

What are the type types of non-papillary bladder malignancy?

Flat non-invasive
Flat invasive

74

What is the gross appearance of transitional cell tumours on imaging?

Single lesion (small papillary vs bulky sessile)
Multiple discrete
Diffuse and confluent

75

Transitional cell carcinoma can present where?

Anywhere along the collecting urinary tract (i.e pelvis, ureters, bladder, urethra, etc)

76

How do papillary transitional cell carcinomas present grossly within the renal pelvis/ureters?

Stippled
Multi centric and bilateral (more commonly unilateral)
Synchronous vs metachronous

77

What percentage of patients with transitional cell carcinomas of the renal pelvis/ureters go on to develop bladder cancer?

50%

78

Over which age do most bladder cancers present?

60

79

Excretory urograms have been replaced by CT urography. T/F

True - excretory urograms are insensitive

80

What can sometimes be seen on imaging of urinary bladder cancer?

Halo sign

81

Which bladder tumours may calcify?

Transitional cell
Sqaumous cell
Urachal cell

82

What is cystica glandularis?

Metaplasia (chronic irritation of bladder mucosa)

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