Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Urinary System > Prostate and Testicular Cancer > Flashcards

Prostate and Testicular Cancer Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the commonest mode of presentation for prostate cancer?

A

Asymptomatic - incidentally noted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is PSA?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the normal level of PSA?

A

0-4ug/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes a transient rise in PSA levels?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What causes a persistent rise in PSA levels?

A

BPH and prostate cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the screening for prostate cancer?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is grading an assessment of?

A

Aggressiveness, based on histological differentiation - biopsy samples are needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is staging an assessment of?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is grading for prostate cancer based on?

A

Gleason sum score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What can staging for prostate cancer be classified into?

A

Clinical staging system
TNM staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the prognostic value of Gleason score?

A

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

24
Q

How is localised prostate cancer staged?

A

Digital rectal examination
PSA
MRI
CT
Bone scan - distant staging

25
Q

What does T1 and T2c mean in staging by DRE?

A

T1 - impalpable disease
T2c - both lobes

26
Q

What are the 4 clinical stages of prostate cancer?

A

Localised stage
Locally advanced stage
Metastatic stage
Castrate-resistant/ Hormone refractory stage

27
Q

What is included in the D’Aminco risk classification for localised disease stage?

A

PSA
Gleason sum score
Clinical T stage
10 year risk of biochemical recurrence

28
Q

What is the treatment for low risk localised prostate cancer?

A

Active surveillance
Surgery - lap, robotic or open
EBRT
Brachytherapy

29
Q

What is the treatment for intermediate and high risk localised prostate cancer?

A

Surgery for intermediate
Then EBRT and brachytherapy
HT - hormone therapy

30
Q

What is the treatment for locally advanced prostate cancer?

A

Watchful waiting
Hormone therapy followed by surgery or radiation
Hormone therapy alone
Intermitted HT

31
Q

What are the types of hormonal therapy for prostate cancer?

A

Surgical castration
Chemical castration
Anti-androgens
Oestrogens

32
Q

Explain chemical castration in treatment for prostate cancer

A

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
Q

Explain anti-androgens in treatment for prostate cancer

A

Inhibits androgen receptors
Not effective on its own - used with LHRH analogue

34
Q

Explain oestrogen in treatment for prostate cancer

A

Inhibits LHRH and testosterone secretion, inactivates androgens and has cytotoxic effects on prostate epithelial cells

35
Q

What is the complications with hormone therapy for prostate cancer?

A

Bone - pain, fractures, anaemia and spinal cord compression
Rectal - constipation and bowel obstruction
Ureteric - obstruction
Pelvic lymphatic obstruction
Lower urinary tract dysfunction

36
Q

What is standard treatment for metastatic prostate cancer?

A

Immediate hormonal therapy
Plus docetaxel in fit patients
Abiraterone and Enzalutamide combined as alternate with HT and steroids

37
Q

Describe the hormone refractory phase

A

Reached in 18-24 months of HT
Management continues with HT and Docetaxel, Abiraterone or Enzalutamide
Alternative is chemo

38
Q

What is the presentation of testicular cancer?

A

Usually - painless lump
Less often - tender inflamed swelling, history of trauma, para-aortic lymph nodes, bone and chest

39
Q

What are the risk factors of testicular cancer?

A

Undescended testis, infertility, atrophic testis, genetic abnormalities, chromosomal abnormalities, race (Caucasian) and previous cancer in contralateral testis

40
Q

What is a precursor lesion of of testicular cancer?

A

Testicular germ cell neoplasia in-situ (TGCNIS)

41
Q

When is peak incidence of testicular cancer?

A

In 3rd decade

42
Q

How is testicular cancer diagnosed?

A

Lump in testis - can be infection, epidydimal cyst and missed testicular torsion
MSSU
Testicular US
Tumour markers

43
Q

What are the types of tumour markers in testicular cancer?

A

AFP - teratoma
BHCG - seminoma
LDH - non specific biomarker of tumour burden
Up to 70& of patients have abnormal tumour markers

44
Q

For testicular cancer, the main lymphatic spread to regional lymph nodes occurs in which group of lymph nodes?

A

Para-aortic lymph nodes

45
Q

What is used for treatment in testicular cancer?

A

Radical orchidectomy using inguinal incision centred over inguinal canal

46
Q

Is biopsy done in testicular cancer?

A

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
Q

What are the types of germ cell tumour?

A

Seminomatous GCT - mainly 30-40 yrs old
Non-seminomatous GCT - mainly 20-30 yrs old and often mixed

48
Q

What are the types of non-germ cell tumour?

A

(sex cord/ stromal cells)
Leydig
Sertoli
Lymphoma - rare

49
Q

How is testicular cancer graded?

A

Based on histological assessment of differentiation
Low grade - well differentiated
High grade - poorly differentiated

50
Q

How is testicular cancer staged?

A

Local staging
Nodal staging - CT scan of para-aortic lymph nodes
Distant staging - CT scan
Tumour markers
TNM staging

51
Q

What are the stages of testicular cancer?

A

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
Q

What does further treatment after orchidectomy depend on?

A

Tumour type, TNM staging and grade

53
Q

What is the treatment for low stage and negative markers in testicular cancer?

A

Orchidectomy followed by surveillance or adjuvant RT or prophylactic chemo

54
Q

What is the treatment for nodal disease, persistent tumour markers or relapse in testicular cancer?

A

Combination chemo or lymph node dissection

55
Q

What is the treatment for metastases in testicular cancer?

A

First line chemo
Second line chemo

56
Q

Describe the prognosis of testicular cancer

A

Overall UK 10 year survival is 98%

Urinary System (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions