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Urinary System > Prostate and Testicular Cancer > Flashcards

Prostate and Testicular Cancer Flashcards

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1
Q

What is the epidemiology of prostate cancer?

A

Commonest cancer diagnosed in men
45% of new cases are >70 yrs
14% of cancer deaths in men - 2nd commonest
Economic burden - £800million/ year

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2
Q

Describe prostate mortality in the UK

A

> 12000 deaths a year
Highest in men aged over 90 years
75% of deaths occur in men over 75 years

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3
Q

What are some risk factors for prostate cancer?

A

Age, race/ ethnicity - African or afro-Caribbean highest risk, geography, FH - first degree relative, HPC1, BRCA1+2 and lynch syndrome, obesity, and diet

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4
Q

Describe presentation and diagnosis with prostate cancer

A

80% are localised
Mostly asymptomatic and diagnosed through opportunistic PSA testing (prostate specific not cancer specific)

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5
Q

What are some of the presenting symptoms of localised prostate cancer?

A

Weak stream, hesitancy, sensation of incomplete emptying, frequency, urgency, urge incontinence and UTI

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6
Q

What are some of presenting symptoms in locally invasive prostate cancer?

A

Haematuria, perineal and suprapubic pain, impotence, incontinence, loin pain or anuria, renal failure, haemospermia, and rectal symptoms

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7
Q

What are some symptoms for metastatic prostate cancer?

A

Bone pain or sciatica, paraplegia secondary to spinal cord compression, lymph node enlargement, lymphoedema and loin pain or anuria

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8
Q

What is the commonest mode of presentation for prostate cancer?

A

Asymptomatic - incidentally noted

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9
Q

What is PSA?

A

Kallikrein serine protease - liquifies semen
Produced by glands of prostate - may leak into serum
Levels increase with age

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10
Q

What is the normal level of PSA?

A

0-4ug/ml

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11
Q

What are age specific ranges for PSA?

A

> 50 years - 2.5 upper limit
50-60 years - 3.5 upper limit
60-70 years - 4.5 upper limit
70 years - 6.5 upper limit

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12
Q

What causes a transient rise in PSA levels?

A

UTI, chronic prostatitis, instrumentation (catheterisation), physiological (ejaculation) and recent urological procedure

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13
Q

What causes a persistent rise in PSA levels?

A

BPH and prostate cancer

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14
Q

How can transient vs persistent rise in PSA be differentiated?

A

Recheck PSA at least in 3 weeks
Half life of PSA is 2.2 days

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15
Q

Describe the probability of cancer based on PSA

A

0-1 - 5%
1-2.5 - 15%
2.5-4 - 25%
4-10 - 40%
>10 - 70%

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16
Q

What is a summary of diagnostic work-up?

A

Serum PSA estimation
Digital rectal exam
Pre-biopsy prostate mpMRI
Biopsy - TRUS guided or MRI fusion targeted
Additional staging

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17
Q

What is the screening for prostate cancer?

A

Do not need national screening programme but have Ad-hoc PSA testing

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18
Q

What is grading an assessment of?

A

Aggressiveness, based on histological differentiation - biopsy samples are needed

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19
Q

What is staging an assessment of?

A

Spread, based on clinical (PSA and DRE) and radiological assessment

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20
Q

What is grading for prostate cancer based on?

A

Gleason sum score

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21
Q

What can staging for prostate cancer be classified into?

A

Clinical staging system
TNM staging

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22
Q

Describe Gleason grading for prostate cancer

A

Pathologist classifies grade of prostate cancer
Score 3-5 well to poor differentiated
Summated to give SUM score
Most common + second most common

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23
Q

What is the prognostic value of Gleason score?

Study These Flashcards
A

6 - 4-30% risk of death
7 - 42-70%
8-10 - 60-87%

24
Q

How is localised prostate cancer staged?

Study These Flashcards
A

Digital rectal examination
PSA
MRI
CT
Bone scan - distant staging

25
What does T1 and T2c mean in staging by DRE?
T1 - impalpable disease T2c - both lobes
26
What are the 4 clinical stages of prostate cancer?
Localised stage Locally advanced stage Metastatic stage Castrate-resistant/ Hormone refractory stage
27
What is included in the D'Aminco risk classification for localised disease stage?
PSA Gleason sum score Clinical T stage 10 year risk of biochemical recurrence
28
What is the treatment for low risk localised prostate cancer?
Active surveillance Surgery - lap, robotic or open EBRT Brachytherapy
29
What is the treatment for intermediate and high risk localised prostate cancer?
Surgery for intermediate Then EBRT and brachytherapy HT - hormone therapy
30
What is the treatment for locally advanced prostate cancer?
Watchful waiting Hormone therapy followed by surgery or radiation Hormone therapy alone Intermitted HT
31
What are the types of hormonal therapy for prostate cancer?
Surgical castration Chemical castration Anti-androgens Oestrogens
32
Explain chemical castration in treatment for prostate cancer
LHRH analogues eventually downregulates androgen receptors by negative feedback Tumour flare in first week so need anti-androgens LHRH antagonists do not cause flare
33
Explain anti-androgens in treatment for prostate cancer
Inhibits androgen receptors Not effective on its own - used with LHRH analogue
34
Explain oestrogen in treatment for prostate cancer
Inhibits LHRH and testosterone secretion, inactivates androgens and has cytotoxic effects on prostate epithelial cells
35
What is the complications with hormone therapy for prostate cancer?
Bone - pain, fractures, anaemia and spinal cord compression Rectal - constipation and bowel obstruction Ureteric - obstruction Pelvic lymphatic obstruction Lower urinary tract dysfunction
36
What is standard treatment for metastatic prostate cancer?
Immediate hormonal therapy Plus docetaxel in fit patients Abiraterone and Enzalutamide combined as alternate with HT and steroids
37
Describe the hormone refractory phase
Reached in 18-24 months of HT Management continues with HT and Docetaxel, Abiraterone or Enzalutamide Alternative is chemo
38
What is the presentation of testicular cancer?
Usually - painless lump Less often - tender inflamed swelling, history of trauma, para-aortic lymph nodes, bone and chest
39
What are the risk factors of testicular cancer?
Undescended testis, infertility, atrophic testis, genetic abnormalities, chromosomal abnormalities, race (Caucasian) and previous cancer in contralateral testis
40
What is a precursor lesion of of testicular cancer?
Testicular germ cell neoplasia in-situ (TGCNIS)
41
When is peak incidence of testicular cancer?
In 3rd decade
42
How is testicular cancer diagnosed?
Lump in testis - can be infection, epidydimal cyst and missed testicular torsion MSSU Testicular US Tumour markers
43
What are the types of tumour markers in testicular cancer?
AFP - teratoma BHCG - seminoma LDH - non specific biomarker of tumour burden Up to 70& of patients have abnormal tumour markers
44
For testicular cancer, the main lymphatic spread to regional lymph nodes occurs in which group of lymph nodes?
Para-aortic lymph nodes
45
What is used for treatment in testicular cancer?
Radical orchidectomy using inguinal incision centred over inguinal canal
46
Is biopsy done in testicular cancer?
Biopsy not performed as risk to tumour seedling along biopsy track May need biopsy of normal contralateral testis if high risk germ cell neoplasia in situ
47
What are the types of germ cell tumour?
Seminomatous GCT - mainly 30-40 yrs old Non-seminomatous GCT - mainly 20-30 yrs old and often mixed
48
What are the types of non-germ cell tumour?
(sex cord/ stromal cells) Leydig Sertoli Lymphoma - rare
49
How is testicular cancer graded?
Based on histological assessment of differentiation Low grade - well differentiated High grade - poorly differentiated
50
How is testicular cancer staged?
Local staging Nodal staging - CT scan of para-aortic lymph nodes Distant staging - CT scan Tumour markers TNM staging
51
What are the stages of testicular cancer?
Stage 1 - confined to testis Stage 2 - infra-diaphragmatic para-aortic lymph nodes involved Stage 3 - supra-diaphragmatic para-aortic lymph nodes Stage 4 - extra-lymphatic disease (lungs, liver and bone)
52
What does further treatment after orchidectomy depend on?
Tumour type, TNM staging and grade
53
What is the treatment for low stage and negative markers in testicular cancer?
Orchidectomy followed by surveillance or adjuvant RT or prophylactic chemo
54
What is the treatment for nodal disease, persistent tumour markers or relapse in testicular cancer?
Combination chemo or lymph node dissection
55
What is the treatment for metastases in testicular cancer?
First line chemo Second line chemo
56
Describe the prognosis of testicular cancer
Overall UK 10 year survival is 98%

Urinary System (26 decks)

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