Benign Prostate Hyperplasia and Prostate Cancer* Flashcards
What is BPH
Non malignant prostate hyperplasia which is typical of ageing
What are the RF for BPH
Age
African
Afro-Car because they have more testosterone
What is a protective factor in BPH
Castration
What is the pathology of BPH
Inner transitional prostate proliferates narrowing the urethra
-Median lobe
How is BPH different to Prostate cancer in terms of proliferation
BPH = Inner transitional zone (MEDIAN LOBE)
Cancer = Outer peripheral zone (Posterior lobe)
Prostate cancer = Outer zone
What are the most common symptoms of BPH
SHID Voiding LUTs symptoms
- Stream poor
- Hesitancy
- Incomplete empty
- Dribbling
ANURIA IF TOTAL URETHRAL OCCLUSION
What are the presentations of BPH
LUTs symptoms (FUNI storage and SHID voiding)
When can anuria present in BPH
Total urethral occlusion causing retention, hydronephrisis, UTI and stones
How is BPH investigated
DRE = Smooth enlarged prostate PSA = sometimes raised
How do the investigations of BPH differ from findnings in Prostate cancer
DRE = Hard Craggy prostate in cancer PSA = More raised in cancer
How can BPH be managed
LIfestyle (decrease caffeine and use catheter)
Drugs 1st = Tamsulosin alpha blocker
2nd = Finasteride 5 alpha reductase
Surgery = TURP (resection)
How does tamsulosin help BPH
Relieves the bladder neck
-Helps Voiding LUTs
How does Finasteride help BPH
Decreases prostate size by decreasing testosterone
What is the major complication of TURP resection in BPH
Retrograde ejaculation
What is prostate cancer
Malignant Neoplastic Adenocarcinoma of outer prostate
What are the RF for prostate cancer
Genes (BRCA2 and HOXB13)
Age
Afro caribbean
How do the RF of prostate cancer differ from BPH
Genetic component as cancer has BRCA2 and HOXB13 association
How does Prostate cancer present
SHID Voiding LUTs like BPH but with cancer Sx
- weight loss
- fatigue
- bone pain
What is the typical metastasis of prostate cancer
Bone by Thick Sclerotic Lesions
Liver
Lung
Brain
How is Prostate cancer investigated
DRE and PSA
Transrectal USS w/ biopsy
GLEASON score
How does the DRE present in Prostate cancer
Hard irregular prostate
What is the tumour grading system for prostate cancer
GLEASON
What is the treatment of prostate cancer
local = Prostatectomy
Mets = Hormone therapy (decrease testosterone)
Radio/Chemo
What is the hormonal therapy used in prostate cancer patients
Bilateral Orchidectomy
GnRH agonist - Goserilin
-increase FSH and LH but supresses the HPG axis so low testosterone
What are the SE of GOSERILIN
Erectile dysfunction
libido loss
In what instances can PSA be raised apart from pathology
Exercise
Ejaculation
UTI
Urine retention
