Week 9 (not Glomerular Injury)

Question 1

Risk factors for prostate cancer

Answer 1

Increasing age
First degree relative diagnosed before age of 60
Afro-Caribbean > Caucasian > Asian

Question 2

Why is there no screening for prostate cancer

Answer 2

Over diagnosis 
Over treatment 
Not cost effective 
Poorer quality of life 
May have benign enlargement of prostate
PSA may be raised in inflammation/infection

Question 3

Presentation of prostate cancer

Answer 3

Usual - asymptomatic (majority), voiding problems, overactive bladder, bone pain
Unusual - haematuria (advanced)

Question 4

How is prostate cancer diagnosed

Answer 4

DRE and serum PSA used to assess whether a biopsy is needed

Transrectal ultrasound guided biopsy

Question 5

How are lower urinary tract symptoms with prostate cancer treated

Answer 5

Transurethral resection of the prostate

Question 6

What factors influence treatment of prostate cancer

Answer 6

Age
Bone scan - sclerotic in bone 
DRE - T1/2 (nodules), T3 (very rough), T4 (rock hard)
Biopsy - Gleason grade 
PSA level

Question 7

Treatment for localised established prostate cancer

Answer 7

Surveillance
Radical prostatectomy
Low dose brachytherapy (implanted beads)

Question 8

Treatment for localised developmental prostate cancer

Answer 8

High dose brachytherapy
High intensity focused ultrasound 
Primary cryotherapy (freeze prostate)

Question 9

Treatment for locally advanced prostate cancer

Answer 9

Surveillance

Hormones (+/- radiotherapy)

Question 10

Treatment for metastatic prostate cancer

Answer 10

Luteinising hormone releasing hormone agonist (eventually lowers LH so lowers testosterone)
Palliative - single dose radiotherapy, bisphosphonates, chemotherapy

Question 11

Types of haematuria

Answer 11

Visible

Non-visible - symptomatic or asymptomatic

Question 12

How is non visible haematuria detected

Answer 12

Microscopy

Urine dipstick

Question 13

Differential diagnosis for haematuria

Answer 13

Cancer (RCC, upper tract TCC, bladder, advanced prostate)
Glomerular injury
Stones
Infection
Inflammation
BPH

Question 14

Important features of history in haematuria

Answer 14

Occupation
Smoking
Family history
Pain
Other lower urinary tract symptoms

Question 15

Things to look for in examination with haematuria

Answer 15

BP
Abdominal mass
Varicocele - collection of veins in scrotum 
Leg swelling
DRE

Question 16

Investigations for haematuria

Answer 16

Flexible cystoscopy
Blood - FBC and Us and Es
Urine culture
Ultrasound - hydronephrosis and kidney tumour

Question 17

Demographics of bladder cancer

Answer 17

2.5 times more likely in males

Usually more advanced in women

Question 18

What is the most common bladder cancer

Answer 18

Transitional cell carcinoma

Question 19

Risk factors for bladder TCC

Answer 19

Smoking
Occupational exposure to arylamines and polyaromatic hydrocarbons
Schistosomiasis

Question 20

Incidence of different bladder cancer stages

Answer 20

75% superficial - T1 or Ta
5% in situ - Tis
20% muscle invasive - T2-4

Question 21

Bladder cancer stages

Answer 21

Tis - just in epithelium, not lumen
Ta - epithelium and lumen 
T1 - subethelial connective tissue (lamina propria)
T2 - into detrusor muscle
T3/4 - into perivesical fat

Question 22

Initial treatment for bladder cancer

Answer 22

Transurethral resection of the bladder cancer

Question 23

Treatment for low risk non muscle invasive bladder TCC

Answer 23

Check cystoscopies

Intravesical chemotherapy

Question 24

Treatment for high risk non muscle invasive bladder TCC

Answer 24

Check cystoscopies

Intravesical immunotherapy

Question 25

Treatment for muscle invasive bladder TCC

Answer 25

If curative - radical cystectomy, radiotherapy, chemotherapy Palliative - chemotherapy or radiotherapy

Question 26

Types and incidence of upper urinary tract tumours

Answer 26

Renal cell carcinoma - 95% Upper tract transitional cell carcinoma - 5%

Question 27

Risk factors of upper urinary tract cancers

Answer 27

RCC - smoking, obesity and dialysis | TCC - smoking, phenacetin abuse and Balkans nephropathy

Question 28

Demographics of renal cell carcinoma

Answer 28

Affects men 1.5 times more than women

Question 29

Where can RCC spread to

Answer 29

Subcapsular fat by perinephric spread Right atrium via renal vein and IVC Lymph nodes Lungs - cannonball metastasis

Question 30

Treatment for localised established RCC

Answer 30

Surveillance Radical nephrectomy - remove kidney, adrenal gland, surrounding fat, upper ureter Partial nephrectomy

Question 31

Treatment for localised developmental RCC

Answer 31

Ablation - removal of tumour from surface via erosion

Question 32

Treatment for metastatic RCC

Answer 32

Palliative - molecular therapies targeting angiogenesis, immunotherapy

Question 33

Investigations for upper tract TCC

Answer 33

Ultrasound - hydronephrosis CT urogram - filling defect or Ureteric stricture Retrograde pyelogram (inject contrast into ureter) Ureteroscopy - biopsy

Question 34

Treatment for upper tract TCC

Answer 34

Nephrourectomy - remove kidney, surrounding fat, ureter and bladder cuff