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Urology > #8. Benign Prostatic Hyperplasia. Carcinoma of the Prostate Gland > Flashcards

#8. Benign Prostatic Hyperplasia. Carcinoma of the Prostate Gland Flashcards

1
Q

In Which Zone of the Prostate does BPH Develop?

A

BPH develops from the PERI-URETHRAL TRANSITIONAL Zone of the Prostate

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2
Q

Is BPH as a finding enough to cause symptoms in patients?

A
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3
Q

What’s the difference between BPH, BPE, BPO?

A

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

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4
Q

What are the 3 groups of LUTS?

A

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

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5
Q

What are the Prostate changes detected by DRE in BPH and Prostate Cancer? Make a Comparison

A

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

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6
Q

Which diseases can present with LUTS?

A
  • Benign Prostatic Obstruction
  • Overactive Bladder
  • Nocturnal Polyuria
  • Underactive Bladder
  • Chronic Pelvic Pain Syndrome
  • Neurogenic Bladder Dysfunction
  • UTIs
  • Urethral Stricture
  • Bladder Tumour
  • Distal Ureteric Stone
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7
Q

What is the International Prostate Symptoms Score (IPSS)?

A
  • Tool used to assess the severity of lower urinary tract symptoms (LUTS) in men.
  • Commonly used to evaluate symptoms associated with BPH
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8
Q

According to IPSS, into what groups are patients with BPH divided?

A
  • 0 -7 = Mildly Symptomatic
  • 8 - 19 = Moderately Symptomatic
  • 20 - 35 = Severely Symptomatic
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9
Q

Can elevated PSA be found in a patient with BPH?

A

YES, elevated PSA can be found in a patient with BPH

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10
Q

Is Prostate Biopsy a Mandatory Test in Diagnosis of BPH?

A

NO - the Mandatory Tests for BPH are:

  • Medical History
  • IPSS
  • Rectal Exam
  • Urination Diary
  • Urine Lab Tests
  • Imaging Tests
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11
Q

What Advice can be Given to Patients with Mild Complaints?

A
  • Prevention of Colds
  • NO Spicy Foods
  • Reduce Alcohol Intake
  • Limit Liquid Intake Late in Evening
  • Physical Activity / Movement are Recommended
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12
Q

What is the MoA of alpha-blockers in patients with BPH?

A
  • Smooth Muscle Relaxation
  • Stream Enhancement
  • Improvement of Symptoms within 1 Week
  • For Moderate - Severe Symptoms
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13
Q

Name at least 1 selective alpha-blocker, its dosage and some of its side effects?

A

SILODOSIN - 8mg Daily

Side Effects include
- Retrograde Ejaculation
- Orthostatic Hypotension
- Intraoperative Floppy Iris Syndrome

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14
Q

What is the MoA of 5-alpha-reductase inhibitors?

A
  • They REDUCE Conversion of Testosterone TO Dihydrotestosterone by 80%
  • WITHOUT Changing Plasma Levels
  • For Moderate - Severe Symptoms
  • SLOWS DOWN Progression of the Disease
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15
Q

Which group of medications has a rapid effect and which group has a delayed effect after several months of starting treatment?

A

RAPID Effect = Alpha-Blockers

DELAYED Effect = Alpha-Reductase Inhibitors

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16
Q

What are the minimally invasive endoscopic methods for treating BPH?

A
  • Transurethral Incision + Resection of Prostate
  • Laser Vaporisation
  • Laser Enucleation
17
Q

What is the incidence of Prostate Cancer?

A
  • Ranks 2nd among ALL Oncological Diseases in Men
  • Ranks 1st in Incidence among Men OVER 75 Years of Age
18
Q

What are the proven Risk Factors for Prostate Cancer?

A
  • 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
19
Q

What are the Symptoms for Prostate Cancer?

A
  • LOWER UT Symptoms (LUTS)
  • Haematospermia
  • Haematuria
  • Obstruction of UPPER UT (Hydronephrosis)
  • Lympoedema of LOWER Limbs
  • Bone Pain
20
Q

What are the Routes of Metastasis and where are the Lymphatic and Distant Metastasis Located in Prostate Cancer?

A

Lymphovascular Route = Pelvic Lymph Nodes

Hematogenous Metastasis = Flat Bones of Pelvis / Vertebrae

21
Q

What are the Indications for Prostate Biopsy?

A
  • ABNORMAL Finding of DRE
  • ELEVATED PSA Levels
22
Q

What is Gleason Score? What is the most common histological type of Prostate Cancer?

A

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
23
Q

Which patients with Prostate Cancer are at low risk?

A
  • PSA Levels are LESS than 10ng / ml
  • Gleason Score is LESS than 7
  • Localised
24
Q

What Imaging Studies are used in Prostate Cancer Staging?

A

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

25
Q

What are the Indications for Radical Prostatectomy?

A
  • 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
26
Q

Can Radiotherapy be used as a Radical Treatment method for Prostate Cancer?

A
  • Radiotherapy = External Irradiation w/ 74 - 78 Gy
  • Low Dose Brachytherapy
27
Q

When is Hormonal Therapy used for Prostate Cancer?

A
  • 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!
28
Q

What is Maximal Androgen Blockade?

A

Lutenising Hormone Releasing Hormone COMBINED With Anti-Androgens

29
Q

What is Castration-Resistant Prostate Cancer and how does it occur?

A

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

30
Q

When is Chemotherapy used in Prostate Cancer?

A
  • Docetaxel and Cabazitaxel = Drugs from Taxane Group
  • They PREVENT Cancer Cells from DESTROYING the Internal Skeleton of the Cell

Urology (15 decks)

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