Prostate and Testicular

Question 1

What is the most commonly diagnosed cancer in males in the UK?

Answer 1

Prostate cancer

Question 2

What is the peak age to be diagnosed with prostate cancer?

Answer 2

60-80

Question 3

What are the definite risk factors for developing prostate cancer?

Answer 3

Age
Race
Family history

Question 4

What are the probable and potential risk factors for developing prostate cancer?

Answer 4

Dietary fat intake
Hormones
Vasectomy
Environment
Diet

Question 5

Which ethnicities have a higher risk for developing prostate cancer?

Answer 5

Caucasian and black males

Question 6

What are the symptoms of local disease of prostate cancer?

Answer 6

Obstructive voiding symptoms
Irritative symptoms
Blocked ejaculatory ducts
Impotence

Question 7

What are the symptoms of advanced/metastatic prostate cancer?

Answer 7

Bone pain
Anaemia
Lymphoedema
Renal failure

Question 8

What are the indications for performing a PSA test?

Answer 8

Lower urinary tract symptoms suggestive of BPH
Abnormal prostate on DRE
Patient concerned about prostate cancer

Question 9

When should a PSA test not be performed?

Answer 9

In presence of retention or infection
Less than 10-year life expectancy
After instrumentation to lower urinary tract (e.g. catheter)

Question 10

What three methods can be used to detect prostate cancer?

Answer 10

DRE
PSA test
Transurethral ultrasound scan

Question 11

What factors determine treatment of prostate cancer?

Answer 11

Gleason grade
TNM stage
PSA level

Question 12

What can be used to treat skeletal complications in hormone refractory prostate cancer?

Answer 12

Bisphosphonates

Question 13

What do bisphosphonates do?

Answer 13

Inhibit osteoclast formation, migration and osteolytic activity
Modulate signalling from osteoblasts to osteoclasts

Question 14

What are the subtypes of testicular cancer?

Answer 14

Germ cell tumours (95%)

Non-germ cell tumours (5%)

Question 15

What are the two main types of testicular germ cell tumour?

Answer 15

Seminoma

Non-seminoma (eg teratoma)

Question 16

What is the age range of diagnosis of testicular germ cell tumours?

Answer 16

15-35

Question 17

What do testicular tumours of older men tend to be?

Answer 17

Spermatocytic seminomas

Testicular lymphomas

Question 18

What are the risk factors for testicular germ cell tumours?

Answer 18

Cryptorchidism
Testicular atrophy
Inguinal hernia
Hydrocoele
Syndromes with abnormal testicular development

Question 19

Testicular cancer is associated with being exposed to high levels of what hormone?

Answer 19

Oestrogen

Question 20

What is testicular carcinoma in situ?

Answer 20

Testicular intraepithelial neoplasia

A precursor for testicular cancer

Question 21

What is the typical symptom that presents with testicular cancer?

Answer 21

Painless swelling of the testis

Question 22

10% of testicular germ cell tumours present with metastases. What symptoms would you see with this?

Answer 22

Respiratory symptoms: Haemoptysis, cough
GI: nausea, haemorrhage
Neurological: CNS, PNS
Lumbar back pain
Lower limb swelling

Question 23

How would you investigate a testicular cancer?

Answer 23

Physical examination
Scrotal ultrasound
Serum tumour marker blood tests

Question 24

What are the serum tumour marker blood tests that should be done for testicular cancer?

Answer 24

Alpha-fetoprotein
Beta-human chorionic gonadotropin
Lactate dehydrogenase

Question 25

Which serum tumour markers are normally elevated in non-seminoma germ cell tumours?

Answer 25

Either AFP or beta-hCG, or both

Question 26

Which serum tumour marker is normally elevated in seminomas?

Answer 26

LDH

Question 27

What is the treatment for a testicular cancer/tumour?

Answer 27

Radical orchidectomy

Question 28

When should a contralateral biopsy be offered?

Answer 28

Testicular volume less than 12cc History of cryptorchidism Age under 30

Question 29

What are the subclassifications of testicular masses?

Answer 29

Intra-testicular | Extra-testicular

Question 30

Which of the two subclassifications of testicular masses tend to be benign?

Answer 30

Extra-testicular

Question 31

What can intra-testicular masses be due to?

Answer 31

``` Malignant primary or secondary tumours Benign tumours Infection Trauma Torsion ```

Question 32

What can extra-testicular masses be due to?

Answer 32

``` Hydrocoele Epididymal cyst Spermatocoeles Varicocoele Epididymitis/orchitis ```

Question 33

Why should undescended testes be treated promptly?

Answer 33

Prevent atrophy | Maintain fertility

Question 34

What risk do small atrophic testicles carry?

Answer 34

Increased risk of malignancy