Flashcards in Ch. 35 WS Deck (40)
Where in the prostate do most cancers occur?
in the peripheral glands
Where in the prostate does most benign hyperplasia occur?
central (periurethral) portion
List the nodes (in order) in which prostate cancer spreads.
Nodes: Periprostatic, obturator, iliac, hypogastric, common iliac, and periaortic.
List the signs and symptoms of prostate cancer (clinical presentation).
Decreased urinary stream, frequency, difficulty in starting urination, dysuria, and infrequently even hematuria.
What is a transurethral resection?
A surgical procedure of the prostate performed for lower urinary tract obstructive symptoms
What is the standard method used to diagnose prostate cancer?
Physical and rectal examination
What is the sensitivity rate for a digital rectal exam?
What is the specificity rate for a digital rectal exam?
What is the most common histologic type of prostate cancer?
What stage disease is prostate cancer that has invaded the seminal vesicles?
What two stages of prostate cancer indicate localized disease limited to the prostate?
T1 and T2
What stage disease is prostate cancer that is fixed to the pelvic sidewall or invaded the bladder or rectum?
What does M1b mean in the staging of prostate cancer?
Metastasized to bone
List the instances in which observation may be a good course of treatment (be sure to read the whole section under the observation heading).
- Patients older than 75 years of age,
- 65-75 year old patients with small, well-differentiated tumors,
- T1-T2 stage tumor,
- Gleason sore of 2-6,
- a PSA less than 10 ng/mL and
- a life expectancy of less than 5 years
Which patients are good candidates for a prostatectomy?
Patients with resectable stage T1 or T2 prostate cancer who are in good general medical condition and have a life expectancy of at least 10 years.
Which patients are good candidates for external beam radiation and what other treatment is often included with radiation?
Stage T3 along with hormone therapy
Which patients are good candidates for radioactive seed implants?
Patients with early stage (T1c, T2a-b), low-grade (Gleason sore ,< or = 6), low PSA(< or =10 ng/mL).
What permanent sources are used for implants?
I-125 and palladium-103
How does hormone therapy work?
Cuts off the supply of testosterone
Which patients are good candidates for chemotherapy?
Patients whose cancer has spread outside of the prostate or whose disease does not respond to hormone therapy.
When receiving external beam radiation, what determines if the seminal vesicles are to be included in the treatment field?
When the risk of involvement is at least in the 10% - 15% range (patients with PSA values greater than 10 ng/mL and with tumors with Gleason scores greater than 6.
What is the conventional dose and fractionation scheme to treat the prostate?
76Gy (7600cGy) in 38 fractions with 2 Gy(200cGy) per fraction.
What is the dose for permanent implants alone?
If a patient is getting external beam radiation followed by permanent seed implants as a boost, what is the typical dose for the external beam portion?
And how much is given during the boost?
110Gy with Iodine-125(I-125) and 90 Gy with Palladium-103(Pd-103)
What is the dose used for HDR and what radioisotope is used?
45.5 Gy using Iridium-192(Ir-192)
List three radioactive isotopes used to treat pain due to metastatic prostate cancer to the bone.
Strontium-89, radium-226, Samarium-153
List some acute side effects of radiation to the prostate.
Diarrhea, abdominal cramping, rectal discomfort, and occasionally rectal bleeding which may be caused by transient proctitis.
What is the clinical presentation for testicular cancer?
Painless swelling or nodular mass in the scrotum
Also sometimes, patients report a dull ache, heaviness, or puling sensation in the scrotum or an aching sensation in the lower abdomen.
Why is a biopsy of the testicular mass not recommended?
Because seeding into the scrotum could occur and further the disease