Prostate and Kidney Cancer (one lecture)

Question 1

Risk factors for prostate cancer

Answer 1

• increasing age (>50)
• diet (high fat)
• family history
• race (african american)

Question 2

What are the different screening methods for prostate cancer?

Answer 2

• Digital rectal exam

- PSA

Question 3

What are the general methods of treating prostate cancer? (4) (if it is confined to the prostate)

Answer 3

• active surveillance (recommended for 2/3 of new cases)
• radical prostatectomy
• external beam radiation
• brachytherapy (radioactive seeds - much less complication than external beam)

** for metastatic cancer: orchiectomy/ medical castration (deprivation of androgens)

Question 4

T/F - early stage prostate cancer can impact the urethra - causing decreased stream

Answer 4

false. it doesn’t affect urethra early on - because it starts in the peripheral zone

Question 5

symptoms of early prostatic disease

Answer 5

none

Question 6

symptoms of progressive prostatic disease

Answer 6

• hesitancy, decreased stream, nocturia
• blood in semen
• impotence
• bone pain (advanced)

Question 7

What is prostate-specific antigen (PSA)?

Answer 7

it is a serine protease which liquefies ejaculate. It is prostate specific but NOT cancer - specific.

Question 8

Ways to enhance PSA specificity

Answer 8

• use age-matched reference values (PSA rises with age)
• measure PSA velocity (>0.75/year rise = suspicious)
• measure PSA density (>0.15 = suspicious for cancer)
• measure % free PSA (low % free is bad)

Question 9

T/F - digital rectal exam can raise someone’s PSA

Answer 9

FALSE

Question 10

T/F: prostate cancer is generally over-diagnosed and over-treated

Answer 10

true. Screening has not been shown to reduce death rate.

Question 11

T/F: in certain studies, prostate screening with PSA was associated with increased mortality

Answer 11

true. (PLCO trial) other trials show benefit.

PLCO trial had many confounders - they were allowed to have 1 prior PSA.. and they had no age-matched reference… plus 50% of people got PSAs outside of the study.

Question 12

Overview of complexities in PLCO trial (showed PSA screening associated with increased death rate)

Answer 12

PLCO trial had many confounders - they were allowed to have 1 prior PSA.. and they had no age-matched reference… plus 50% of people got PSAs outside of the study.

Question 13

benefits of screening for prostate cancer

Answer 13

-catch it earlier, more localized

Question 14

Who should be screened for prostate cancer?

Answer 14

• Screen 55-69 - prime age, and age where treatment makes the biggest difference
• Screen 40-55 years if other risk factors (family history, African American)
• DO NOT screen under 40 years.

Question 15

T/F Patients with lower urinary tract symptoms should be checked for PSA.

Answer 15

True.

Question 16

If someone has elevated PSA or a positive digital rectal exam, what is the next step?

Answer 16

-get a transurethral ultrasound-guided biopsy

Question 17

Most common site of metastasis for prostate cancer

Answer 17

lumbar spine

Question 18

T/F: transurethral ultrasound of the prostate is a reasonable alternative to PSA screening.

Answer 18

False. It is not a screening method.

Question 19

epidemiology of kidney cancer

Answer 19

• Renal Cell Carcinoma (RCC) makes up 85-90% of all primary renal neoplasms. Typically gray, spherical mass on CT
• 3% of all adult cancer deaths in the USA
• males more common than females
• quite fatal (1/3 die of the disease and 1/4 have metastatic disease at birth)

Question 20

risk factors for kidney cancer (6)

Answer 20

• Cigarrette smoking
• Obesity
• hypertension
• renal cystic disease (in end stage renal disease)
• Family syndromes - Von Hippel Lindau and Tuberous sclerosis.

Question 21

differential diagnosis for a solid renal mass

Answer 21

• Renal Cell Carcinoma until proven otherwise! (70-85% of all renal masses)
• oncocytomas (identical to RCC)
• angiomyolipomas (fat density (black shading) by CT)
• urothelial carcinoma

Less common:

• metastasis to the kidney
• renal abscess (if fever)
• adrenal tumor
• lymphoma

Question 22

What are the different histologic subtypes of renal cancer?

Answer 22

Malignant

• clear cell (85% of RCC) - most common
• papillary = second most common
• chromophobe

Benign

• oncocytoma
• angiomyolipoma

Question 23

Workup for new onset renal cancer - what does it consist of ?

Answer 23

CT scan with contrast = best test. (ultrasound should not be used on its own, but may help determine if cystic.)

Question 24

Staging system overview for renal cancer

Answer 24

T1 = confined to kidney, 7cm
T3 - into major veins or perinephric tissue
T4 = beyond Gerota’s fascia

Question 25

What are the two major treatment options for renal cancer?

Answer 25

Surgery is the mainstay of treatment. *Partial nephrectomy (more commonly done, preserves renal fxn, less morbidity/mortality) *Radical nephrectomy (take the whole kidney out - rarely done now) Note: also, laparoscopic cryotherapy/ ablation also available.

Question 26

T/F - 50% of renal masses are detected incidentally

Answer 26

True!!

Question 27

classic triad for renal cancer

Answer 27

-flank pain -palpable mass -hematuria this occurs in

Question 28

T/F: Paraneoplastic syndromes are common in kidney cancer.

Answer 28

True. PTH-rp is produced in 10% of tumors, while EPO is produced in 5% of tumors

Question 29

Renal cancer workup for metastatic disease

Answer 29

- CXR - bone scan if elevated alk phos or bone pain - LFTs, serum calcium, CBC - head CT/MRI if symptoms or widely metastatic disease

Question 30

T/F Renal biopsy is part of the workup for kidney cancer.

Answer 30

False. Generally not done

Question 31

T/F Renal biopsy is always done before removing the kidney in the case of a renal mass.

Answer 31

FALSE. Not done for large tumors - they just take it out (complications from biopsy, many times indecisive, may miss tumor. Just take the kidney out instead).. However, it may be done for small tumors, suspected lymphoma, or high surgical risk pts)

Question 32

T/F: Despite not being curative, taking out the kidney improves survival in metastatic renal cancer.

Answer 32

True.