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Flashcards in GU Cancer Deck (65)
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1

Types of GU Cancers

Prostate
Testicular
Penile
Bladder
Renal
Wilms tumor

2

Epidemiology of Prostate Cancer

2nd most common cancer in men
Clinical incidence doesn't match prevalence at autopsy

3

Types of Prostate Cancer

Adenocarcinoma (most common)
Sarcomas
Small cell carcinomas
Transitional cell carcinomas
Neuroendocrine tumors

4

Risk Factors for Prostate Cancer

Age: 40+ years
Race: higher in African-American men
Family history: two fold greater risk with 1st-degree relative
Genetic: BRCA2
Environmental carcinogens: agent orange

5

Clinical Presentation of Prostate Cancer

Early stage cancer: asymptomatic
Symptoms may include: urinary frequency/urgency, nocturne, hesitancy
Hematuria/hematospermia
Bone pain

6

Diagnosis of Prostate Cancer

DRE: nodules, induration, asymmetry
Transrectal ultrasound (TRUS)
MRI
Bone scan

7

Pathology of Prostate Cancer

Acinar cells develop into adenocarcinoma

8

Zones of the Prostate

Peripheral zone
Central zones
Transition zone

9

Which zone of the prostate are a majority of prostate cancers found?

Peripheral zone

10

Grading of Prostate Cancer

Gleason grade: well-differentiated (grade 1) to poorly differentiated (grade 5)
Gleason score = primary tumor grade + secondary tumor grade

11

Staging of Prostate Cancer

Stage 1: found in prostate only
Stage 2: tumor that is too small to be felt or seen on image test (2a) or larger tumor that can be felt on DRE (2b)
Stage 3: cancer has spread beyond the outer layers of the prostate into nearby tissues & maybe seminal vesicles
Stage 4: any tumor that has spread to other parts of the body

12

Risk Classification of Prostate Cancer

Low risk: T1-T2a & Gleason score T2c or Gleason score 8-10 or PSA >20

13

Define Gleason Score

Describes how aggressive the cancer is and how quickly it can spread

14

Treatment of Prostate Cancer

Active surveillance
Open radical prostatectomy vs. minimally invasive radical prostatectomy (MIRP)
Radiation
High-intensity focused ultrasound (HIFU)
Hormone therapy

15

When can you use active surveillance in the treatment of prostate cancer?

Gleason score

16

When would you use an open radical prostatectomy or MIRP?

Gleason score 6+

17

Types of Radiation for Treatment of Prostate Cancer

External beam
High dose radiation (HDR)
Brachytherapy

18

When can you use hormone therapy for prostate cancer?

Diagnosed in their 70s & 80s & don't want other treatment
Orchiectomy
Androgen deprivation LHRH

19

Advantages of External Beam Radiation Therapy

Effective long-term cancer control with high-dose treatment
Low risk of urinary incontinence
Available for cure of patients over a wide range of ages & in those with significant comorbidity

20

Advantages of Brachytherapy

Cancer control rates appear equal to surgery & EBRT for organ-confined tumors
Quicker than EBRT
Available for cure of patient over a wide range of ages & in those with some comorbidity

21

Advantages of Radical Prostatectomy

Effective long-term cancer control
Predictions of prognosis can be more precise based on pathologic features in specimen
Pelvic lymph node dissection is possible through the same incision
PSA failure is easy to detect

22

Advantages of Active Surveillance

Reduces over treatment
Avoids or postpones treatment-associated complications
Has no effect on work or social activities

23

Disadvantages of External Beam Radiation Therapy

Significant risk of impotence
Lack of lymph node removed
Knowledge of possible metastasis to lymph nodes not available
Up to half of patients have some temporary bladder or bowel symptoms during treatment

24

Disadvantages of Brachytherapy

Significant risk of impotence
Lack of lymph node removal
Up to half of patients have some temporary bladder or bowel symptoms with treatment

25

Disadvantages of Radical Prostatectomy

Significant risk of impotence
Risk of operative morbidity
Low risk of long-term incontinence

26

Disadvantages of Active Surveillance

Tumor may progress beyond possibility for cure
Later treatment may result in more SE
Living with untreated cancer may cause anxiety

27

Relative Contraindications to External Beam Radiation Therapy

Previous pelvic irradiation
Active inflammatory disease of the rectum
Very low bladder capacity
Chronic moderate or severe diarrhea from any cause

28

Relative Contraindications to Brachytherapy

Previous pelvic irradiation
Large-volume gland
Marked voiding symptoms
Large or high-grade tumor burdens
Chronic moderate or severe diarrhea
Active inflammatory disease of the rectum

29

Relative Contraindications for Radical prostatectomy

Higher medical operative risk
Neurogenic bladder

30

Relative Contraindications for Active Surveillance

Patients with high prostate cancer anxiety
High-grade tumors (>6 Gleason score)
Prolonged expected survival