5.04 Urology - The Prostate Flashcards
What is prostatitis?
Inflammation of the prostate gland, most commonly of bacterial aetiology.
Give the pathophysiology of acute bacterial prostatitis.
Ascending urethral bacterial infection, most commonly caused by Escherichia coli.
What are the risk factors for acute bacterial prostatitis?
- indwelling catheters
- phimosis
- urethral strictures
- cystoscopy
- immunocompromised
What are the clinical features of acute bacterial prostatitis?
- LUTS
- pyrexia
- perineal or suprapubic pain
- urethral discharge
OE tender prostate and inguinal lymphadenopathy.
What investigations should be used to assess suspected prostatitis?
- urine culture
- STI screen
- routine bloods (FBC, CRP and U&Es)
Why is PSA often not performed when assessing prostatitis?
PSA will be falsely raised and adds no clinical benefit to outcome.
What is the management of prostatitis?
- antibiotic therapy (targeted)
- analgesia
- tamsulosin or finasteride second line
What is benign prostatic hyperplasia?
The benign hyperplasia of the prostate leading to an increase in its size.
What is the function of the prostate?
The prostate converts testosterone to dihydrotestosterone (DHT) using the enzyme 5a-reductase.
What are the risk factors for BPH?
- increasing age
- family history
- black African or Caribeean ethnicity
- obesity
What are the clinical features of BPH?
- LUTS (voiding)
- haematuria
- haematospermia
OE DRE shows firm, smooth prostate.
NOTE as part of initial assessment, every patient should complete International Prostate Symptom Score (IPSS).
What are the differential diagnoses for BPH?
- prostate cancer
- UTI
- overactive bladder
- bladder cancer
What investigations can be used to assess BPH?
- urinary frequency and volume chart
- beside urinalysis
- post-void vladder scan
- PSA test
- ultrasound scan
- urodynamic studies
What lifestyle advice can be given to a patient to manage BPH?
- moderate caffeine and alcohol intake
- weight loss
- smoking cessation
What is the medical management of BPH?
- Tamsulosin
- Finasteride
Outline the action of tamsulosin in the treatment of BPH.
Alpha blocker used first line, therefore relaxes prostatic smooth muscle and allowing symptomatic benefit within days.
Outline the action of finasteride in the treatment of BPH.
5a-reductase inhibitor used second line, preventing the conversion of testosterone to DHT.
What medication is often co-prescribed alongside finasteride due to its adverse effect of ED?
PDE V inhibitor
If conservative management of BPH fails, what are the options?
TURP to endoscopically remove prostatic tissue and increase urethral lumen size.
What are the common complications of TURP?
- TUR syndrome
- haemorrhage
- sexual dysfunction
- retrograde ejaculation
- urethral stricture
What is TUR syndrome?
A life-threatening complication of TURP.
The use of hypoosmolar fluid during surgery causes fluid overload and dilutional hyponatraemia.
Saline is now more commonly used to prevent TUR syndrome.
What are the common complications of BPH?
- high-pressure urinary renention
- post-renal kidney injury
- UTIs
- haematuria
- urinary retention
What is the most common cancer in men?
Prostate cancer
What is the most common subtype of prostate cancer?
Adenocarcinoma (95%)
Prostate cancer most commonly affects which zone of the prostate?
Peripheral zone
What are the risk factors for prostate cancer?
- increasing age
- black African or Caribbean ethnicity
- family history of prostate cancer
- obesity
- smoking
- diabetes mellitus
NB exercise considered protective.
What specific genetic mutations predispose to prostate cancer?
BRCA1 or BRCA2 gene
What are the clinical features of prostate cancer?
- LUTS (late)
- haematuria
- dysuria
- incontinence
- haematospermia
- suprapubic pain
- loin pain
- rectal tenesmus
Screen for metastatic bone disease etc.
DRE of prostate cancer shows…
- asymmetrical
- nodular
- irregular masses
What are the differential diagnoses for prostate cancer?
- BPH
- prostatitis
- bladder cancer
- urinary stones
What tests can be used to investigate prostate cancer?
- PSA
Note can also be raised due to prostatitis, DRE, BPH. Not specific enough to confirm diagnosis but can support.
What imaging technique is used to assess prostate cancer?
MRI scan of the prostate to target biopsy.
Can also use CT chest-abdomen-pelvis and PET-CT to stage prostate cancer.
Which grading system is used to classify prostate cancers?
Gleason grading system.
How is prostate cancer managed?
- active surveillance if low risk
- radical prostatectomy (open, laparoscopically, robotically)
- chemotherapy
