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64 Cards in this Set
- Front
- Back
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PROSTATE: epidemiology |
most common male cancer, lung is second second most deadly, lung is first |
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PROSTATE: what age gets it |
70 |
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PROSTATE: by age ____, ____ of all men will have some form of prostate cancer |
by age 90, 80% |
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PROSTATE: new cases and deaths |
decreasing |
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PROSTATE: etiology |
cadmium exposure farmers rubber exposure high fat diets |
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PROSTATE: _______ have localized cancer at time of diagnosis |
58% |
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PROSTATE: how do they present? |
most are asymptomatic or only have symptoms of lower urinary tract obstruction if advanced patient can present with bladder outlet obstruction urinary retention uremia |
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PROSTATE: common presentation of mets |
bone pain |
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PROSTATE: clinical exams |
digital rectal exam: over 50 annually, and if high risk start at 40 |
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PROSTATE: lab exams |
prostate specific antigen: annually
above 4-10: 22% positive biopsy rate above 10: 66% positive biopsy rate 40-50: locally advanced or metastatic disease CBC SMA-12 PAP (prostatic acid phosphatase) - useful to diagnose metastatic disease |
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PROSTATE: imaging exams |
bone scan CT MRI |
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PROSTATE: prognostic indicators -stage and differentiation |
high stage and less differentiation have worse prognosis |
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PROSTATE: prognostic indicators =age |
increased local failure if under 60 survival not significantly influenced by age |
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PROSTATE: prognostic indicator -race |
african americans present at later stage no difference when males stratified by pretreatment prognostic factors |
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PROSTATE: prognostic indicators -PSA level |
negative indicator if positive after XRT or surgery
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PROSTATE: prognostic indicators - +LN status |
at 10 yrs post treament 90% of pts with positive nodes with have distant mets |
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PROSTATE: prognostic indicators -transurethral resection |
core needle biopsy is more definitive in diagnosing disease. TURP is too central |
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PROSTATE: local growth pattern |
malignant diseases are usually multifocal and in periphery of gland benign disease presents in center of gland |
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PROSTATE: most common pathology |
adenocarcinoma |
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gleason score ranges from |
2-10 based on glandular differentiation and growth pattern |
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PROSTATE: three types of surgery and when is it used |
radical prostatectomy - for surgical cure, used for young A1, A2, B1, B2 pelvic lymphadenoectomy - provides better staging but has no therapeutic value cryosurgery - used for early stage lesions |
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PROSTATE: chemotherapy |
basically uneffective some better outcomes with multi-agent chemo regimens |
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PROSTATE: hormone therapy
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androgen ablation -chemically: LUPRON used to eliminate testosterone production or ESTROGEN can be given -surgically - orchiectomy |
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PROSTATE: immunotherapy |
provenge- reprograms your own immune cells to turn on ability to recognize prostate cancer cells |
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PROSTATE: 7 radiation therapy techniques |
standard 4 field standard 4 field with HDR 3D conformal therapy (ART) IMRT multiple obliques rotational arcs brachytherapy |
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PROSTATE: standard 4 field for ADVANCED prostate cancer -ant -post |
ant: 1cm post public symphysis post: include pre-sacral nodes, sparing of post portion of rectal wall |
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PROSTATE: purpose of 3d conformal therapy |
allows high doses with much less toxicity uses CT and MLC to reate very customized beam shapes max dose to minimal normal tissue improve dose distribution |
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PROSTATE: 3d conformal therapy vs IMRT |
conformal therapy - adjusts BEAM SHAPE to maximze dose and minimize normal tissue tx IMRT - varies BEAM INTENSITY THROUGH LEAF SHAPING to max dose and minimize normal tissue tx |
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PROSTATE: multiple oblique fields |
was great when first introduced 6 oblique fields used to spare bladder and rectum |
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PROSTATE: bilateral arcs |
used as a boost tx to the prostate effective during its time to spare rectum and bladder 3d conformal and IMRT have replaced this |
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Brachytherapy dose to the prostate |
8000 cgy bladder and rectum get 5000-6000 cgy |
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PROSTATE: type of permanent brachy implant |
palladium 103 |
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PROSTATE: type of removable brachy implant |
iridium 192 |
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PROSTATE: brachy boost dose |
45 gy XRT to prostate, seminal vesicles and pelvic nodes if at risk HDR temporary implant dose 500 cgy x 3 fx LDR permanent implant dose ~100 gy |
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PROSTATE: brachy alone dose |
LDR 115-145 gy |
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PROSTATE: radical prostatectomy outcome |
5 year survival: 80-85% 10 year: 70% 15 years: 50% |
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PROSTATE: XRT for early stage outcome |
5 year: 75-80% 10 yr: 65-70% |
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PROSTATE: XRT for patients with extracapsular extention outcome |
5 year: 55-60% 10 year: 35-45% |
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PROSTATE: palliative RT -local mets -distant mets |
local mets - 5000-6000 cgy distant mets - 3000-3500 cgy |
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PROSTATE: radioactive injectable options for palliate bone pain |
strontium 89 - best results radioactive phophorus 32 yttrium 90 |
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protons dose with lateral fields only |
76-82 Gy lateral good for sparing bladder and rectum |
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when are protons not good when tx the prostate |
when treating the seminal vesicles if they wrap around the posterior rectum. causes too hot of dose to recutm |
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4 field standard prostate field F.S. |
10x10 |
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PROSTATE: where do you put c/a |
sup portion of pubic symphysis |
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PROSTATE: when do you perform radiation post prostatecomty |
if PSA doesn't dec after surgery PSA undetectable but margins are positive or seminal vesicles involved PSA undetectable after sx then begins to rise |
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PROSTATE: dose of radiation post prostatectomy |
PSA undetectable 66 gy PSA rising 70 gy |
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TESTICULAR: epidemiology |
rare most common in men between 20 and 34 7400 new cases, 370 deaths high rate in US, UK, and denmark |
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TESTICULAR: etiology |
gonadal dysgenesis - approx 10% have history of maldescent cryptorchidism - undescended testes. 35x greater risk of developing testicular cancer, inc risk of developing intra-abdominal testicular tumor 23% of pts with a history of cryptorchidism and unilateral tesicular cancer also have carcinoma in situ in other testes 50% with carcinoma in situ develop malignant disease within 5 years DES (diethylstilbesterol) - used to prevent miscarriages from 1938 - 1970 |
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TESTICULAR: DES exposure non malignant symptoms |
meatal stenosis - narrowing of urethral opening hypospadias - uretral opening on the underside of penis |
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TESTICULAR: DES exposure malignant symptom |
cryptorchidism |
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primary drainage of male reproductive system |
retroperitoneal lumbar nodes thoracic duct mediastinum supraclavicular nodes axillary nodes (rare) |
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TESTICULAR: clinical presentation |
painless swelling in the scrotum, but pain and tenderness can be common pulling on scrotum, dull ache in pelvis, feeling of heavy pelvis back pain and/or abdominal swelling indicates retroperitoneal involvement |
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TESTICULAR: what node signifies mets from thoracic or abdominal organ |
left virchow's node |
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TESTICULAR: can present with male breasts called... |
gynecomastia approx 5% of pts with testicular germ cell tumors develop gynecomastia |
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TESTICULAR: testicular torsion |
10% have acute and severe pain possible related to torsion of spermatic cord |
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TESTICULAR: histology |
seminoma |
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TESTICULAR: where do testicular cancer arise from |
95% from germ cells |
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three subtypes of seminomas |
classical anaplastic spermatocytic -no prognostic difference between subtype |
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four subtypes of non-seminomas |
embryonal carcinoma teratoma carinoma choriocarcinoma yolk sac tumor |
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which is the most common subtype of nonseminoma |
embryonal carinoma, often present with mixed cell elements |
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route of spread for seminomas |
tend to remain localized involve only lymph nodes spread orderly from retroperitoneal to mediastinal nodes to supraclavicular very rarely spreads hematogenously less than 5% have stage 3 or 4 at time of presentation |
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route of spread for non seminomas |
hematogenous typically involve liver and lung |
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TESTICULAR: type of surgery |
orchiectomy - resection of testicle bilateral retroperitoneal lymph node dissection for embroyonal carinoma, teratocarinoma, teratoma, seminoma |
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TESTICULAR - when is surgery not recommended |
surgery is not recommended for non-seminomas and metastatic disease until complete response from surgery |
