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flucas
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What anatomical structures does the prostate gland lie next to?
- rectum
- urinary bladder
- seminal vesicles
- vas deferens (ampulla)
- autonomic nerves (alpha-adrenergic)
- (pelvic lymph nodes)
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In which zone does prostate cancer usually develop?
- peripheral zone
- (area adjacent to rectal wall)
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In which zone does BPH develop?
transition zone
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Does family history correlate with increased risk for prostate cancer?
- Yes
- FHx of prostate cancer: >2x increased risk
- no specific genes identified yet
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Is there a minimal serum PSA value below which cancer is not found?
- no
- (~ 7% of men with prostate cancer in this study has a serum PSA < 0.5 ng/ml)
There is NO threshold ABOVE which there is always cancer or BELOW which there is never cancer
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How specific is an “abnormal” digital rectal exam (DRE) for cancer of the prostate?
- not very
- BPH: can have firm nodules but non-malignant
- Prostate cancer: malignant but does not normally form firm nodules
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What are the 3 main risk factors for developing benign prostatic hyperplasia?
- 1. Age
- 2. Intact Androgen pathway
- (no BPH if prepubertal orchiectomy)
- 3. Family History of BPH
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What (specific) complications might occur if BPH is not treated?
- Acute urinary retention
- Chronic obstruction:
- Bacterial cystitis & pyelonephritis
- Bladder stones
- Hydronephrosis & chronic renal failure
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What (general) complications might occur if BPH is not treated?
- dilated renal collecting system (hydronephrosis, pyelonephritis)
- dilated ureters (hydroureter)
- dilated, trabeculated bladder
- chronic bladder obstruction (cystitis, ball-valve effect)
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What are the 2 main components of "lower urinary tract syndrome"?
- 1. mechanical obstruction
- 2. neurogenic
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What are the options for treating BPH?
- Removal of prostate tissue: TURP (transurethral resection of prostate), Suprapubic prostatectomy Androgen blockade
- Inhibition of alpha-adrenergic enervation
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What are some side effects of trans-urethral resection of the prostate (TURP)?
- Side effects:
- stricture
- bleeding
- incontinence
- impotence
- 15 % develop symptoms requiring another TURP within 10 years
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What are some risk factors for prostate cancer?
- Older age
- Intact hypothalamic-pituitary-testis axis
- African-Americans have prostate cancer at a younger age and higher rate than whites.
- Incidence increases 5-fold in Japanese who emigrate to the USA
- family history of prostate, breast or brain cancer.
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A set of prostate biopsies showed prostate adenocarcinoma. What additional information provided in the biopsy is useful for deciding how to manage this patient’s cancer?
- The grade of the cancer: Grading is based on how well-formed the glands are (the Gleason system).
- Using the Partin tables, the grade, serum PSA and the clinical stage the probability of the cancer being confined to the prostate can be determined.
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What is a "grade" of cancer?
- Grade = How well differentiated a tumor is
- How closely tumor histologically resembles non-tumor, normal cells of that organ:
- Low-grade = Close resemblance
- High- grade = Little resemblance
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What is meant by a "stage" of cancer?
- Stage = Where the tumor is at time of diagnosis
- Localized = Tumor is confined to the organ of origin
- Regional spread = Tumor has invaded adjacent organs
- Metastatic = Discontinuous spread of tumor to other tissues
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What is the lowest score on the Gleason cancer grading system? highest score?
- lowest score: 2 (1 + 1)
- highest score: 10 (5 + 5)
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What are the advantages and limitations of different options for treating a primary prostate cancer?
- Choices of therapy:
- Radical prostatectomy
- Radiation therapy (Implantation of radioactive seeds (brachytherapy))
- External beam
- Hormonal blockade
- Watchful waiting/active surveillance
- Side effects:
- Incontinence
- Impotence
- Fissures
- Strictures
- Loss of libido
- Osteoporosis
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What are the eligibility requirements for having an "active surveillance" approach to prostate cancer treatement? What is "active surveillance"?
- Eligibility:
- clinical stage T1
- PSA level ≤ 20 ng/mL
- Gleason score < 7
- PSA measured and a DRE conducted at 3-6 month intervals.
- Decision between continued monitoring or definitive therapy is informed by rate of rise of PSA and patient - clinician decision
- 80% of patients still on active surveillance at 10 yrs.
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Which organ does metastatic prostate cancer preferentially affect?
- Prostate cancer has high proclivity for bone; these metastases are usually osteoblastic and the source of marked pain.
- The majority of patients who die of prostate cancer have widespread bone metastases
- 100% of bone metastases invasion in the right iliac decreasing slightly throughout the spine and the thoracic cage to 64% in the left humerus.
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Some men whose cancers have been retarded by androgen deprivation therapy present later with metastatic cancer. What is the mechanism for prostate cancer progression in these cases?
- Presumably, the selection for prostate cancer cells that don’t depend on androgen receptor activation for proliferation.
- There is evidence that prostate cancer cells can produce sufficient androgen to activate androgen-dependent pathways
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True/False: The majority of patients with prostate cancer die from the disease.
- False
- Only a minority of patients develop progressive tumor
- Only a minority of these patients die of prostate cancer
- The majority die of cardiovascular disease
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How will you screen a patient for prostate carcinoma and what is the effectiveness of these screening method(s)?
- Screening techniques:
- Digital rectal exam (DRE)
- Serum PSA
- Efficacy:
- DRE is insensitive and relatively nonspecific
- Specificity and sensitivity of serum PSA for detecting prostate cancer is low
- Prevention:
- Diet5 alpha reductase blockade, i.e. finasteride
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Is serum PSA a good screening assay for detecting primary prostate cancer?
- No
- Serum PSA “measures” the size of the prostate regardless of whether there is cancer (either low- or high-grade)
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True/False: Routine PSA exams are recommended for people over the age of 75.
- False
- P.S.A. screening is currently not advised for those 75 and older.
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What are the 4 basic medications that affect the androgen pathway and are used to prevent/treat prostate cancer? What are the common side effects of these drugs?
- 1. estrogens (prevent LHRH release from hypothalamus)
- 2. LHRH analogues (prevent pituitary stimulation)
- 3. finasteride; a.k.a. propecia (5-alpha-reductase inhibitor)
- 4. AR antagonists (prevent AR stimulation)
- side effects:
- hot flashes
- decreased libido
- gynecomastia
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