Benign Prostatic Hypertrophy and Prostate Carcinoma Flashcards
Lower urinary tract symptoms (LUTS) can be divided obstructive and irritative symptoms.
What are the irritative symptoms?
FUND
- Frequency
- Urgency
- Nocturia
- Dysuria
What are the obstructive LUTS symptoms?
- Hesitancy
- Sensation of incomplete bladder emptying
- Diminished urinary stream
- Post voiding urinary dribbling
What is BPH?
- Hyperplasia resulting in LUTS
- Common with age
- Proliferation occurs in transition zone
- Leads to restriction of prostatic urethra and urinary flow
What are the clinical features of BPH?
- Urinary frequency
- Nocturia
- Incomplete emptying
- Reduced urinary flow
- Dribbling
- Hesitancy
- Retention
Investigations are targeted at confirming the diagnosis, excluding malignancy and assess for complications.
What are key investigations for BPH?
- Digital rectal examination
- Urine → dipstick / MSU / post-void residual
- Bloods → FBC / U+Es / LFTs
- PSA → vigorous exercise and ejaculation avoided 48hrs before test
- USS / MRI prostate
- Uroflowmetry
- Others → cysto-urethrogram / urethrocystoscopy / urodynamics
Malignancy must be excluded in men presenting with symptoms of BPH.
What is the conservative management?
- Watchful-waiting in mild disease
- Medical and surgical therapies have complications which may be avoided or delayed
- Long-term catheter, with changes every 3 months
What is the medical treatment for BPH?
- Alpha blockers (tamsulosin) → help with LUTS; don’t impact acute retention rates or need for surgery
- 5-a reductase inhibitors (finasteride) → take up to 6m to work; SEs (reduced libido, ED); can cause fall in PSA; reduce rate for acute retention and surgery need
What are surgical options for BPH?
- Transurethral Resection of Prostate (TURP) → common; can cause retrograde ejaculation, UTI, catheter need, clot retention, incontinence, stricture, ED
- Transurethral Incision of Prostate (TUIP) → involves incision of outlet as opposed to resection; suitable for small prostates (< 30ml)
- Holmium Laser Enucleartion of Prostate (HoLEP) → suitable for large prostates; laser also results in reduced blood loss + often shorter post-op stay
- Greenlight laser PVP
- Prostatic urethral lift
- Open prostatectomy → for v large prostates >80-100ml;
What are features and causes of prostate cancer?
- Most frequently diagnosed cancer in men + leading cause of cancer-specific death in men
- 5yr survival is 80% w/ localised disease, 20-30% if mets present
- Typically adenocarcinomas
- Dependent on androgens for growth
- Incidence is higher in black people than in Europeans + least freq in Asians
- Genetic role in 10%
What are clinical features of prostate cancer?
- Bone pain caused by metastatic deposits (1st presentation in 30%)
- LUTS
- Bladder outflow obstruction
Which investigations for prostate cancer?
- PR → enlarged, hard and craggy prostate suggests cancer
- PSA → levels >10 need investigating
- Transrectal US → USS is used to estimate prostate volume + to guide needle biopsy
What is the Gleason score?
- Graded using number 1-5
What is the TNM staging for prostate cancer?
What is the treatment for localised prostate cancer (T1/T2)?
Treatment depends on life expectancy + patient choice
- Conservative → active monitoring + watchful waiting
- Radical prostatectomy
- Radiotherapy
What is the treatment for localised advanced prostate cancer (T3/T4)?
- Hormonal therapy
- Radical prostatectomy
- Radiotherapy → external beam + brachytherapy
