urology 1 – Flashcard
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PSA or prostate specific antigen is ______ dependent
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androgen dependent
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PSA is structurally . chemically
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serine protease
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what is the best time of day for a PSA?
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doesn't matter, does not fluctuate
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increases pSA
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prostate cancer BPH, prostatitis age manipulation or trauma Ejaculation
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what medication can decrease PSA levels?
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5 alpha reductase inhibitors
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decreases PSA
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5 alpha reductase inhibitors (designed to help reduce size of prostate, also used for hair loss) androgen : deprivation/castration Prostate surgery Radiation Therapy
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normal PSA 40-49
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0-2.5
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normal PSA 50-59
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0- 3.5
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normal PSA 60-69
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0- 4.5
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normal PSA 70-75
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0-6.5
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white male or AA male tend to have higher PSA?
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AA males more likely to have higher PSA levels than caucasian OR asian men
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PSA velocity greater than _____ suggests prostate CA
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PSA velocity ; .75 ng/ ml. yr
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how many readings (and how often can you obtain them) do you need to get PSA velocity?
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3 separate readings, have to be taken @ least 6 m apart
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how do you get PSA density?
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PSA/ PSA velocity
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what PSA density suggests prostate cancer
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; .15
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how can PSA be found in the blood?
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PSA can be free or complexed
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when is free PSA useful? btw what PSA levels?
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% free PSA can be helpful for defining risk of Prostate cancer when PSA is btw 4 and 10
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w/ regards to prostate cancer, PSA increases the risk for what increases
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As PSA increases, the risk for capsular penetration, LN metastasis, seminal vesicle invasion and distant metastasis increases
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what is the most common internal tumor in US males
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prostate cancer
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second leading cause of cancer death's in males?
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prostate (lung first)
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how deadly is prostate CA?
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most prostate cancers will not cause death (10% who get it will die)
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most common type of prostate CA tumor?
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adenocarcinoma
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earlier stages and in generally most symptoms of Prostate Ca...
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MOSTLY prostate cancer is asx
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what are some advanced sx of prostate cancer
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-bone pain (can incr osteoblastic activity) -hematuria -urinary obstruction
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whites or blacks more likely to get prostate CA
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African Americans
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what age is your risk for prostate cancer really increased
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after 65
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does fam hx play a role in prostate cancer risk?
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YES especially if first degree relative has
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although out of date, old standards for prostate screening HIGH RISK
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around 40-45 start
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although out of date, old standards for prostate screening low- normal risk
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50
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new stardards say generally to screen men btw
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55-69
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new standards say that once start screening your men btw 55-69 the screening should be done _____
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every two years as opposed to every year
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what do you use to aid you in bx prostate?
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ultrasound
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routine bx of prostate consists of
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12 cores of tissue in systemic fashion
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aggression _____ w/ increasing gleason scale #
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increases
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tx options prostate cancer
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Surgery (radical) Radiation-External Beam and Brachytherapy (implantable radioactive seeds) Cryotherapy Active Surveillance hormonal therapy chemo
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microscopic hematuria is defined as
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presence of > 3 RBC/ hpf on 2 or 3 properly collected urine specimen
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hematuria diff dx
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Menstrual Period Prostate Obstructive Uropathy Trauma Tumor (Bladder, Kidney, Ureteral, Urethral) Stones Thrombosis Hematologic (anticoagulation, Sickle Cell, bleeding disorders) Infection/Inflammation History of Radiation
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is a dipstick + for blood enough?
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no, need to send for microscopic analysis (Highly sensitive, less specific)
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what else do you want to order after + dipstick/ microscopy for hematuria?
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urinalysis/ urine culture urine cytology upper tract imaging cystoscopy
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renal mass protocol (also order if cannot find reason for hematuria)
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3 phase CT non contrasted
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what is the MC site of cancer in the urinary system?
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bladder
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most common type of bladder cancer
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transitional cell carcinoma
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MC type of prostate CA ____ MC type of bladder CA ____ MC type of testicular CA
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prostate cancer: adenocarcinoma bladder cancer: transitional cell carcinoma testicular: Germ cell tumors (90-95%)
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males or females more likely to get bladder CA?
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MALES more likely to get bladder CA
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bladder CA is HIGHLY associated with what unnecessary risk factor
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smoking
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smoking HUGE risk factor for bladder CA, others?
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chronic cystitis chronic UTI chronic catheterization bladder stones schistomosomiasis (infection caused by snails) chemical exposure radiation exposure cyclophosphamide (med used in chemo)
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early sx of bladder CA
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painless hematuria irrative sx
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late sx bladder cancer
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flank pain from urinary obstruction bone pain pelvic mass
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low grade non invasive bladder tumors long term problem
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can recur
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bladder CA tx
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transurethral resection of bladder tumor intravesicular chemo (VCG) radical cystectomy
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Most testicular cancers are
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germ cell tumors
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risk factors for testicular cancer
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undescended testicle HIV gonadal dysgenesis testicular feminization
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___ sided testicular CA more common... why
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right sided testicular CA more common (bc right testicular has higher rate of not descending)
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painful/ painless lump more likely to be cancer
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painless
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what feeling in their testis might you undx testicular CA pt describe?
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"testicular heaviness"
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you have recently confirmed your pt has testicular CA, they start complaining of pain here and you worry of metastasis
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back pain from retroperitoneal metastasis
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your male pt presents with ______ and you know narrow down that this weird finding could be nothing other than testicular CA. what is this finding?
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gynecomastia
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what dx test/ imaging might you want to order first for your testicular lump pt?
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ultrasound eventually CT
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what tumor markers do you order your potential testicular cancer patient?
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AFP B HCG LDH
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what tests do you order to look for metastasis?
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BUN, CR (looking for tumor in kidneys) LFT
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your testicular patient had normal ultrasound, but to be sure you ordered the CT (as is the order). However, the CT is abnormal- what do you order next
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chest CT/ x ray
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what do you want to recommended for your young testicular CA pt?
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sperm banking
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you find testicular CA, standard tx is
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radical inguinal orchiectomy (as quickly as possible)
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how are most renal tumors found?
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incidentally
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classic triad of renal tumor (but rarely present w/- only 10%)
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flank mass hematuria pain
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what % of your renal tumor pt will have mets on presentation
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25-30% (yikes, thats a little more than a 1/4 of pt w/ renal CA will already have metastasis)
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imaging studies suspected renal tumor?
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CT scan CxR
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labs for suspected renal tumor
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CBC BUN/ Cr, LFT's Alkaline phsphate Ca
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what type of CT for potential renal tumor pt
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three phase
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what system do you use to classify renal cysts:
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Bosniak renal cyst
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BR. Cyst classifcation 1
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simple cyst hairline thin wall no septa, calcifications, or solid components water attenuation, no enhancement
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on CT ________ is hallmark of renal carcinoma
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enhancement
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Bosniak RC classification 2
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has a few septa that are hairline
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bosniak RC classification 2f
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septa is a little thick
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Bosniak RC classification 3
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has measurable enhancement w/in septa
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bosniak RC classification IV
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all characteristics of III clearly malignant also contain distinct enhancing soft tissue components independent of cyst wall or septa
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which bosniak renal cysts do you excise?
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III IV
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type of benign renal tumors:
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pseudotumors simple cyst adenoma angiomyolipoma oncocytoma juxtaglomerular tumor multilocular cystic nephroma mesoblastic nephroma
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types of malignant renal tumors
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renal cell carcinoma wilm's clar cell sarcoma rhabdoid tumor leiomyosarcoma
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NUMBER ONE RISK FACTOR FOR RENAL CELL CARCINOMA
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smoking
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other risk factors for renal tumors
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VHL, tuberous sclerosis, family history, horseshoe kidney (never ascended to normal position), acquired polycystic kidney disease, obesity, diuretics
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what is a horse shoe kidney?
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never ascended to proper position
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what % of renal tumor pt have paraneoplastic syndrome? prognosis?
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Paraneoplastic Syndromes occur in 30% of patients-when the symptoms persist after tumor resection, metastatic disease is present and these patients have a poor prognosis
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paraneoplastic syndrome of renal tumors
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fever, weight loss, cachexia, elevated ESR anemia, hypercalcemia, polycythemia hypertension (elevated renin) Stauffer's syndrome (hepatitis not associated with liver mets)
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when there is renal cell carcinoma metastasis usually involve ____ site(s)
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multiple sites
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MC to least common sites of renal tumor metastasis
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Lung Bone regional nodes liver ipsilateral adrenal contralateral kidney brain
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renal carcinoma treatments
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radical nephrectomy partial nephrectomy (depends on size and location of the tumor)
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indications for partial nephrectomies
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solitary kidney, bilateral tumors, poor renal function, contralateral kidney is threatened by disease, elective
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MC primary malignant renal tumor in childhood
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Wilm's tumor
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MC presenting sign of Wilm's tumor
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abdominal mass + (65% have HTN)
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two unusual presentations of Wilm's tumor
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aniridia hypospadias
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Most to least common sites of Renal tumors
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Lung Liver Bone brain
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Wilms tumor tx
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surgical exploration and removal chemo before if unresectable @ presentation
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WIlms tumor
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84% relapse free survival at 2 yrs
