#8. Benign Prostatic Hyperplasia. Carcinoma of the Prostate Gland Flashcards
In Which Zone of the Prostate does BPH Develop?
BPH develops from the PERI-URETHRAL TRANSITIONAL Zone of the Prostate
Is BPH as a finding enough to cause symptoms in patients?
What’s the difference between BPH, BPE, BPO?
1) Benign Prostatic Hyperplasia = Growth of Peri-urethral Zone, including increased n.o of epithelial and stromal cells
2) Benign Prostatic Enlargement = Consequence of Hyperplasia of the Glands
3) Benign Prostatic Obstruction = Result of Hyperplasia + Enlargement
What are the 3 groups of LUTS?
1) Storage Symptoms
- Urgency
- Nocturia
- Frequency
- Urinary Incontinence
2) Voiding Symptoms
- Hesistancy
- Spraying
- Poor Flow
- Straining
- Terminal Dribbling
3) Post-Micturition
- Post-Micturition Dribble
- Feeling in Incomplete Emptying
What are the Prostate changes detected by DRE in BPH and Prostate Cancer? Make a Comparison
1) DRE in BPH = Enlarged Prostate BUT with Clear Limits and WITHOUT Thickening / Hard Areas
2) DRE in Prostate Cancer = Area with Cartilaginous Density / Entire Prostate is Cartilaginous with UNCLEAR Edges
Which diseases can present with LUTS?
- Benign Prostatic Obstruction
- Overactive Bladder
- Nocturnal Polyuria
- Underactive Bladder
- Chronic Pelvic Pain Syndrome
- Neurogenic Bladder Dysfunction
- UTIs
- Urethral Stricture
- Bladder Tumour
- Distal Ureteric Stone
What is the International Prostate Symptoms Score (IPSS)?
- Tool used to assess the severity of lower urinary tract symptoms (LUTS) in men.
- Commonly used to evaluate symptoms associated with BPH
According to IPSS, into what groups are patients with BPH divided?
- 0 -7 = Mildly Symptomatic
- 8 - 19 = Moderately Symptomatic
- 20 - 35 = Severely Symptomatic
Can elevated PSA be found in a patient with BPH?
YES, elevated PSA can be found in a patient with BPH
Is Prostate Biopsy a Mandatory Test in Diagnosis of BPH?
NO - the Mandatory Tests for BPH are:
- Medical History
- IPSS
- Rectal Exam
- Urination Diary
- Urine Lab Tests
- Imaging Tests
What Advice can be Given to Patients with Mild Complaints?
- Prevention of Colds
- NO Spicy Foods
- Reduce Alcohol Intake
- Limit Liquid Intake Late in Evening
- Physical Activity / Movement are Recommended
What is the MoA of alpha-blockers in patients with BPH?
- Smooth Muscle Relaxation
- Stream Enhancement
- Improvement of Symptoms within 1 Week
- For Moderate - Severe Symptoms
Name at least 1 selective alpha-blocker, its dosage and some of its side effects?
SILODOSIN - 8mg Daily
Side Effects include
- Retrograde Ejaculation
- Orthostatic Hypotension
- Intraoperative Floppy Iris Syndrome
What is the MoA of 5-alpha-reductase inhibitors?
- They REDUCE Conversion of Testosterone TO Dihydrotestosterone by 80%
- WITHOUT Changing Plasma Levels
- For Moderate - Severe Symptoms
- SLOWS DOWN Progression of the Disease
Which group of medications has a rapid effect and which group has a delayed effect after several months of starting treatment?
RAPID Effect = Alpha-Blockers
DELAYED Effect = Alpha-Reductase Inhibitors
What are the minimally invasive endoscopic methods for treating BPH?
- Transurethral Incision + Resection of Prostate
- Laser Vaporisation
- Laser Enucleation
What is the incidence of Prostate Cancer?
- Ranks 2nd among ALL Oncological Diseases in Men
- Ranks 1st in Incidence among Men OVER 75 Years of Age
What are the proven Risk Factors for Prostate Cancer?
- Age = Incidence INCREASES with Age
- Race = BLACK People, in Africa have HIGHER Incidence
- Hereditary = 1st Line Relatives have 2-4x HIGHER Risk (9%)
- INCREASED Intake of Red Meat / Vitamin D / Calcium / Import of Animal Fats
What are the Symptoms for Prostate Cancer?
- LOWER UT Symptoms (LUTS)
- Haematospermia
- Haematuria
- Obstruction of UPPER UT (Hydronephrosis)
- Lympoedema of LOWER Limbs
- Bone Pain
What are the Routes of Metastasis and where are the Lymphatic and Distant Metastasis Located in Prostate Cancer?
Lymphovascular Route = Pelvic Lymph Nodes
Hematogenous Metastasis = Flat Bones of Pelvis / Vertebrae
What are the Indications for Prostate Biopsy?
- ABNORMAL Finding of DRE
- ELEVATED PSA Levels
What is Gleason Score? What is the most common histological type of Prostate Cancer?
Gleason Score = Sum of 2 Most Common Types of Cancer Cells in Biopsy (Scale: 1 - 5)
- Ranging from 2 - 10 Points
- MOST COMMON Histological Type = Adenocarcinoma
(i) Acinar = MORE Common
(ii) Ductal = LESS Common
Which patients with Prostate Cancer are at low risk?
- PSA Levels are LESS than 10ng / ml
- Gleason Score is LESS than 7
- Localised
What Imaging Studies are used in Prostate Cancer Staging?
1) T-Category = MRI
2) N-Category = CT / MRI / PET with Ga-Prostate Specific Membrane Antigen
3) M-Category = Bone Scintigraphy w/ 99Tc / MRI or PET
What are the Indications for Radical Prostatectomy?
- MORE than 10 Years Life Expectancy
- Have Radical Prostatectomy WITHOUT Lymphatic Dissection
- Where ENTIRE Prostate w/ Seminal Vesicles is Surgically Removed
- Anastomosis is Performed BTW Bladder Neck AND Membranous Urethra
Can Radiotherapy be used as a Radical Treatment method for Prostate Cancer?
- Radiotherapy = External Irradiation w/ 74 - 78 Gy
- Low Dose Brachytherapy
When is Hormonal Therapy used for Prostate Cancer?
- When the Patients are at HIGH RISK
- Androgen-Suppressing Monotherapy is done
- Patients are UNWILLING / UNABLE to receive any form of LOCAL Therapy (Prostatectomy / Radiotherapy)
- IF their PSA Levels DOUBLE within 12 Months!
What is Maximal Androgen Blockade?
Lutenising Hormone Releasing Hormone COMBINED With Anti-Androgens
What is Castration-Resistant Prostate Cancer and how does it occur?
CRPC = Castrate Serum Testosterone is LESS than 50ng/ml or 1/7nmol/L
1) Adrenal Androgen Secretion
2) Androgen Receptor Amplification / Mutation and Paracrine / Intracrine and Androgen Production
When is Chemotherapy used in Prostate Cancer?
- Docetaxel and Cabazitaxel = Drugs from Taxane Group
- They PREVENT Cancer Cells from DESTROYING the Internal Skeleton of the Cell
