Male Associated Malignancies

What four malignancies are covered in the Male Associated Malignancies lecture?

Prostate cancer, testicular cancer, penile cancer, and male urethral cancer.

Where is the prostate gland located?

Below the urinary bladder and in front of the rectum.

What is the normal size of the prostate gland?

Approximately the size of a walnut.

What size is the prostate gland at birth?

Approximately the size of a pea.

When does the prostate experience two growth spurts?

During puberty and around age 50.

What is the function of prostate cells?

They produce fluid contained in seminal fluid that nourishes sperm.

What structure runs through the center of the prostate and carries urine and semen out of the body?

The urethra.

What is the second leading cause of cancer death in American men?

Prostate cancer, behind lung cancer.

Is prostate cancer always fatal?

No. Although it can be serious depending on the stage, most men diagnosed with prostate cancer do not die from it.

Why is prostate cancer sometimes called a "watch and wait disease"?

Some lower-grade prostate cancers grow slowly and may be monitored rather than treated immediately.

Approximately how many men in the United States diagnosed with prostate cancer are still alive according to the lecture?

3.1 million.

How does the incidence of prostate cancer change with age?

The incidence increases with each decade of life.

At what age is prostate cancer rare?

Before age 40.

What percentage of prostate cancer cases occur in men over age 65 according to the lecture?

65%.

Which racial group has a higher incidence of prostate cancer?

African-American men.

In which geographic region is prostate cancer more common?

North America.

How does having a first-degree relative with prostate cancer affect risk?

A father or brother with prostate cancer can double a man's risk. The risk is higher with an affected brother.

What are the less clearly established risk factors for prostate cancer?

Diet, obesity, smoking, chemical exposure, and vasectomy.

What dietary factor is mentioned as a possible prostate cancer risk factor?

Increased dairy products may slightly increase the chance of developing prostate cancer. The slide has a fill-in-the-blank.

What does the lecture say about obesity and prostate cancer?

The relationship is unclear. Some studies suggest obesity is associated with a lower risk of low-grade cancer but a higher risk of aggressive cancer.

What does the lecture say about smoking and prostate cancer?

The relationship is still being researched.

What chemical exposures are mentioned as possible prostate cancer risk factors?

Agent Orange and possible occupational chemical exposures, including among firefighters.

What two methods are used for early detection and screening of prostate cancer?

Digital rectal examination (DRE) and prostate-specific antigen (PSA) testing.

What is a digital rectal examination (DRE)?

A physical examination in which a healthcare provider feels the prostate through the rectum to check for nodules or abnormalities.

Why is a DRE useful for detecting prostate cancer?

Many prostate cancers begin in the back part of the prostate gland, where nodules may be felt.

How often does the lecture recommend a DRE for men over age 50?

Annually.

What does PSA stand for?

Prostate-specific antigen.

Why does the normal PSA range depend on age?

The prostate enlarges as men age, which can affect PSA levels.

At what age should average-risk men consider prostate cancer screening according to the lecture?

Age 50, if they are expected to live at least 10 more years.

At what age should high-risk men consider prostate cancer screening according to the lecture?

Age 45.

Who is considered high risk for prostate cancer screening at age 45?

African-American men and men with a first-degree relative diagnosed at age 65 or earlier.

At what age should men at even higher risk consider prostate cancer screening?

Age 40.

Who is considered at even higher risk and may begin screening at age 40?

Men with more than one first-degree relative with prostate cancer at any age.

What PSA level is commonly associated with prostate cancer developing?

PSA usually rises above 4 ng/mL.

Does a PSA below 4 ng/mL rule out prostate cancer?

No. Approximately 15% of men with a PSA below 4 will still have prostate cancer on biopsy.

What is the approximate chance of prostate cancer when PSA is between 4 and 10 ng/mL?

About 1 in 4.

What is the approximate chance of prostate cancer when PSA is above 10 ng/mL?

Over 50%.

What are common clinical symptoms of prostate cancer?

Decreased urinary stream, urinary frequency, difficulty starting urination, dysuria, occasional hematuria, and blood in semen.

What does dysuria mean?

Painful or difficult urination.

What does hematuria mean?

Blood in the urine.

What can bone pain indicate in prostate cancer?

More extensive or later-stage disease.

What neurological symptoms can occur with extensive prostate cancer?

Lower extremity numbness or weakness.

What bladder or bowel symptoms can occur with extensive prostate cancer?

Bladder or bowel incontinence.

What are the methods used to establish a diagnosis of prostate cancer?

DRE, PSA testing, transrectal ultrasound-guided biopsy, and transrectal MRI.

What percentage of prostatic nodules found during rectal examination are confirmed malignant at biopsy according to the lecture?

50%.

Why is a biopsy necessary to diagnose prostate cancer?

A histologic diagnosis is required to confirm cancer.

What is transrectal MRI useful for?

Detecting smaller prostate tumors.

What is a Gleason score?

A grading system that evaluates how much prostate cancer cells resemble normal prostate tissue.

What is the Gleason grading scale?

Grades range from 1 to 5.

What does a Gleason grade of 1 indicate?

The tissue looks a lot like normal prostate tissue.

What does a Gleason grade of 5 indicate?

The tissue looks very abnormal.

How is the Gleason score calculated?

Two grades representing the areas that make up most of the cancer are added together.

What is the Gleason score range described in the lecture?

1 to 10.

What Gleason score is considered low grade?

6 or less.

What Gleason score is considered intermediate grade?

7.

What Gleason score is considered high grade?

8 to 10.

What does a PSA below 10 ng/mL generally indicate regarding detectable metastatic disease?

Detectable metastatic disease is rare.

What staging system is used for prostate cancer?

The TNM staging system.

What are the prognostic factors for prostate cancer listed in the lecture?

Gleason grading/score, DNA analysis by flow cytometry, PSA level, and predictive models for organ-confined versus non-organ-confined disease.

What imaging and tests are used for prostate cancer detection and diagnosis?

Abdominal and pelvic CT scans, chest X-ray, bone scan, liver function tests, and serum PSA.

What are the treatment techniques for prostate cancer?

Observation, surgery, external beam radiation therapy (EBRT), brachytherapy, and hormonal therapy.

When can observation be considered for prostate cancer?

In lower-grade disease.

What two treatments are considered equally effective when prostate cancer is limited to the prostate?

Radical prostatectomy and radiation therapy.

What is a radical prostatectomy?

Surgical removal of the prostate gland.

What is the Da Vinci robot used for in prostate cancer treatment?

Robotic-assisted surgery.

How does the surgeon operate the Da Vinci robot?

From a console with a 3-D screen, using grasp controls to manipulate surgical instruments.

How do the robotic arms of the Da Vinci system work?

They translate the surgeon's finger, hand, and wrist movements into movements of surgical tools.

What is a major advantage of the Da Vinci robotic system?

Very high precision.

What is the goal of external beam radiation therapy (EBRT) for prostate cancer?

Maximize damage to the prostate while minimizing damage to surrounding tissues, especially the bladder and rectum.

When do most acute side effects of external beam radiation occur?

During treatment, and they usually subside after treatment is completed.

What gastrointestinal side effects can occur with prostate EBRT?

Diarrhea, abdominal cramping, rectal discomfort, and occasional rectal bleeding.

What other acute side effects can occur with prostate EBRT?

Fatigue, frequent urination, painful urination, and blood in the urine.

What are late side effects of prostate EBRT?

Persistent proctitis, rectal bleeding, and ulceration.

How does increased radiation dose affect rectal side effects?

Higher doses can cause worse rectal side effects.

Why can urinary urgency and frequency be difficult to avoid during prostate radiation treatment?

The urethra runs through the prostate and may be affected by radiation.

How does erectile dysfunction compare between EBRT and radical prostatectomy?

It is less common following radiation treatment than radical prostatectomy, but recovery is slower and depends on age and function before treatment.

What does the word "brachy" mean?

Short.

What does "therapy" mean?

Treatment.

What is brachytherapy?

Radiation treatment in which radioactive sources are placed close to or directly inside the target volume.

How are radioactive sources usually contained in brachytherapy?

They are sealed within small metal structures, usually titanium or stainless-steel tubes welded shut at the ends.

What are the three brachytherapy dose-rate categories?

Low dose rate (LDR), medium dose rate, and high dose rate (HDR).

What is the dose-rate range for LDR brachytherapy?

Under 2 Gy/hr.

What is the dose-rate range for medium dose-rate brachytherapy?

2 Gy/hr to 12 Gy/hr.

What is the dose rate for HDR brachytherapy?

Higher than 12 Gy/hr.

What are the four main brachytherapy applications?

Interstitial, intraluminal, intracavitary, and surface.

What is interstitial brachytherapy?

Placement of a radioactive source directly into a tumor or tumor bed.

What devices can be used for interstitial brachytherapy?

Rigid needles or flexible tubes.

What are common uses of interstitial brachytherapy?

Neck, breast, prostate, and soft tissue sarcomas.

What is intraluminal brachytherapy?

Placement of radioactive sources within body tubes.

What devices are used for intraluminal brachytherapy?

Catheters and various centering applicators.

What are common uses of intraluminal brachytherapy?

Esophagus, trachea, and bronchus.

What is intracavitary brachytherapy?

Placement of a radioactive source directly inside a body cavity.

What are the most common sites for intracavitary brachytherapy?

Uterus, cervix, and vagina.

What is surface brachytherapy?

Placement of radioactive sources on top of the area being treated.

What are common uses of surface brachytherapy?

Nonmelanoma skin cancer, oral cavity, nasal cavity, hard palate, orbital cavity, and eye plaque.

What are examples of permanent brachytherapy implants?

Prostate implants.

What are examples of temporary interstitial brachytherapy implants?

Temporary breast implants, including SAVI, catheter-based implants, balloon-based implants, and intraoperative radiation therapy-based implants.

What are examples of intracavitary GYN brachytherapy?

Cervical and vaginal treatments, including tandem and ovoids and vaginal cylinders.

How is LDR prostate brachytherapy performed?

Radioactive seeds are implanted into the prostate through ultrasound-guided needles.

Is anesthesia required for LDR prostate brachytherapy?

Yes.