Male reproductive cancers

What is the organ that secrets testosterone and produces sperm?

testes

Note: the testes produce 90 to 95% of testosterone in the body

what organ stores sperm that are going to mature?

epididymis

what organ transfers the sperm from the epididymis to the seminal vesicles

vas deferens

where does the sperm transfers to after it matures in the epididymis?

seminal vesicles

The sperm gets trasferred to the seminal vesicles through the vas deferens by __________ through the ejaculatory ducts.

muscle contraction

What gland surrounds the first part of the urethra and the ejaculatory ducts at the base of the urethra, just below the bladder?

prostate gland

Name the anatomy

name the anatomy

name the anatomy

name the lymph nodes

in regard of male reproductive cancers, what is the first line of spread for the pelvic lymph nodes?

1. periprostatic nodes

2. obturator nodes

In regard of male reproductive cancers, what is the second line of spread of the pelvic lymph nodes

• external illiac

• internal iliac / hypogastric nodes

• common iliac nodes

• paraaortic nodes

What are the lymph nodes a standard prostatectomy LN dissection sample target?

• obturator fossa nodes

• external iliac nodes

what is the difference between exocrine and endocrine glands?

• Exocrine glands excrete substances through a duct

• Endocrine glands secrete substances directly into a cavity without a duct

What is the function of the penile bulb?

Provides support to the penis during exitation

True or false: The fluid the prostate gland produces forms part of the semen.

True

what protein does the prostate produce? It is also considered a tumor marker.

Prostate specific antigen (PSA)

The _______ plays a part in controlling the flow of urine.

Prostate

Where is the largest node of the penile lymphatic drainage found?

It’s found underneath the inguinal ligament

Where does the penile lymphatic drainage occur?

• In the inguinal nodes (deep and superficial)

• external nodes

• para-aortic nodes

Where do the lymphatic drainage of the testes occur?

• Para-aortic and iliac nodes

Note: Regional spread through the lymphatic pathway consist of the retroperitoeal, para-aortic, and renal hilar nodes

What is the puch of skin that envelops the testes called?

scrotum

Why are the testes located outside the body

It is due to the temperature. Sperm develops at a temperature cooler than the normal internal body heat

What is the most common malignancy (cancer) in males

prostate cancer, which occurs in 1 in 9 men

At what age does prostate cancer most commonly occur in men?

It is most common amongst men aged > 65 y.o

Which of the male reproductive cancers occurs less than 1% of all male cancers

Testicular cancer

Where is penile cancer most frequently found on the penis?

Anywhere on the penis, but more often on the foreskin of uncircumcised men or the glans

What is the rate (percentage) of men developing penile cancer?

< 1% (rare)

At what age does penile cancer most commonly occur in men?

the rate of this cancer has increased amongst men > 60 y.o

At what age does testicular cancer most commonly occur in men?

It’s common in men aged 15 to 35 y.o

Define cryptorchidism

A condition where one or both of the testes fail to descend into the scrotum before birth

Is testicular cancer more common on the right or left testes?

most common on the right

True or false: 2% of men diagnosed with testicular cancer have a history of cryptorchidism

False: 50% of men have a history of cryptorchidism

Testicular cancer is most common amongst what ethnic group?

White males

Gene mutations are one of the common causes of prostate cancer. What are the 2 most common genes?

• HOXB13

• BRCA2

What are some etiological factors / causes associated with prostate cancer?

• obesity

• family history of prostate cancer

• tall adult height

• black ethnicity

• gene mutations

What are some clinical presentations / symptoms of prostate cancer?

• asymptomatic in early stages

• difficulty peeing

• polyuria

• nocturia

• urgency

• dysuria (pain when urinating)

• hematuria (blood in urine)

• Late: bone pain, weight loss, fatigue, anemia, weakness/numbness in legs or feet

What are some clinical presentations / symptoms of penile cancer?

• non-healing sore

• lump

• foul smell with discharge

• itching (puritis)

• inguinal mass - nodes involved 30% - 45%

What are some clinical presentations / symptoms of testicular cancer?

• pain / discomfort in testes

• ache in lower abdomen or groin

• build up of fluid in scrotum

• gynecomastia

• painless lump/swelling

• change in how testes feel

• Late: abdominal mass, urethral obstruction, pulmonary symptoms

Define gynecomastia

a condition where the breast tissue enlarges in men, typically caused by an imbalance of hormones (estrogen and testosterone)

What can an increased PSA test indicate?

• proctitis

• Benign Prostate Hyperplasia (BPH) - enlargement of prostate

• prostate cancer

what is the normal range of PSA?

< 4 ng / mL

What are some investigations or diagnosis done for prostate cancer

• clinical or history examination

• MRi or CT scan

• Bone scan

• DRE

• tumor marker tests: PSA

• PET lab studies: CBC, urinalysis, liver and renal functions

• Gleason score

• Biopsy: core needle / TRUS

How doe a biopsy work for prostate diagnosis

A needle is inserted through the wall of the rectum into the prostate gland to look for abnormalities.

Note: also known as endorectal ultrasound (ERUS)

Which lobe of the prostate gland is the most aggressive when affected by cancer and why?

Central Zone: median lobe because it tends to spread to the seminal vesicles

Note: 20% of prostate cancers occur in this zone

In which zone of the prostate gland does 70% of prostate cancers occur?:

Peripheral zone: posterior lobe

What zone of the prostate gland does BPH primarily occur in

Transitional zone: anterior lobe

Note: this zone consists of 5% - 15% of prostate cancers

What cancer consists of 95% adenocarcinomas?

Prostate cancer

Penile cancers mainly consist of what type of cell?

Squamous cell carcinoma (SCC)

Note: adenocarcinomas, melanomas, sarcomas, basal cell carcinomas (BCC) are rare for this cancer

There are 2 main classifications for testicular cancer. What are they?

Seminomas and Non-Seminomas

Note: when a tumor contains both seminoma and non seminoma, then it is treated as a non seminoma

Note: Seminomas are more common

At what age range do testicular seminoma cancer occur

They occur in men between 25 and 45

True or false: spermatocytic seminomas are a rare type of seminomas

true

Note: grows slowly and less likely to spread to other areas

Note: occurs in older men about 65 y.o

True or false: 95% of seminomas are classical GCT (Germ Cell Tumor) in regard of testicular cancer

True

what are the 4 main types of non-seminoma tumours

1. embryonal carcinoma

2. yolk sac carcinoma

3. choriocarcinoma

4. teratoma

What is the 5-Year survival rate percentage for prostate cancer locally, regionally, and distantly?

Local: 100% (stage I + II)

Regional: 100% (stage III)

Distant: 31% (stage IV)

What is the relative 10-Year survival rate for prostate cancer?

91%

What is the relative 15-Year survival rate for prostate cancer?

76%

What is a prostatectomy?

Surgery to remove the prostate

What are the 2 types of radical prostatectomy and define them

Retropubic prostatetomy: surgery through an incision is made in the abdomen

Perineal prostatectomy: surgery through an incision made between the scrotum and the anus

What are some risk factors related to a prostatectomy

• bowel incontinence

• urine incontinence

• urinal stricture (tightness of the urinary opening from the scar tissue)

• impotence

• injury to the rectum

Other than the testes, what other gland is able to secrete testosterone

Adrenal glands

Note: adrenal gland produces 5 to 10% of testosterone

what is an orchiectomy

surgery to remove the testes

what are the different types of hormone therapy used?

1. Luteinizing Hormone-Releasing Hormones (LHRH) agonists / Gonadotropin-Releasing Hormones (GnRH) agonists / LHRH analogs

2. LHRH antagonists / GnRH antagonists

3. Anti-androgens

4. Androgen synthesis inhibitors

How are LHRH agonists used in hormone therapy and give examples of drugs used.

enhances the production of LH, causing the pituitary to rest from the increase of androgens (flare-up effect). testosterone levels start to drop

Drugs used: Zoladex, Lupron, Lupron depot, Eligard, Trelstar

How are LHRH antagonists used in hormone therapy, and give examples of drugs used.

block / reduces the pituitary’s receptor to produce of LH / FSH, causing the testes to stop the production of testosterone. Faster than LHRH agonists

Drugs used: Firmagon

How are anti-androgens used, and give examples of drugs used.

blocks the use of testosterone as its used as the same time as LHRH agonists. Its also taken for a few weeks (30 days) to reduce tumor flare reaction

Drugs used: Casodex

How are androgen synthesis inhibitors used, and give examples of drugs used.

used for advanced or mets patients. It blocks enzymes needed to produce testosterone, and the production of cortisol

Drugs used: Zytiga

How is hormone therapy administered?

Injection:

• subcutaneous or into muscle (abdomen) for LHRH

• once a month every 6 months

Orally medication daily for ant-androgens

How do Dr follow up with hormone therapy

Regular blood tests:

• PSA levels

• testosterone levels

When is hormone therapy considered the primary treatment modality for a prostate case?

• Early stage to shrink the tumor before radiotherapy or surgery

• tumor beyond prostate walls - spread to other areas (mets)

• recurrent or risk of recurrence

How does hormone therapy work for a prostate case

It blocks or reduces the of androgens from being used

for a prostate case, what are some possible side effects of hormone therapy

• hot flashes

• sexual problems (ex: impotence, low sex drive, etc)

• fatigue

• osteoporosis (condition that weakens bones)

• gynecomastasia + breast tenderness