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Urology > BPH and Prostate Cancer > Flashcards

BPH and Prostate Cancer Flashcards

1
Q

What is Benign Prostate Hyperplasia?

A
  • Overgrowth of prostatic tissue in the transition zone of the prostate
  • Results in the formation of large nodules
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2
Q

What are the different zones of the epithelium?

A

=> Transition zone - BPH affected
=> Central zone - (not actually central)
=> Peripheral zone - prostate cancer affected

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3
Q

What is the pathophysiology of BPH?

A

Oestrogen levels in the blood increase with age. This leads to increased expression of oestrogen receptors on the prostate, which increases androgen levels in the prostate. Increased androgen levels in the prostate cause an increase in growth of the stromal and epithelial cells.

=> Increase in the number of stromal and epithelial cells further increases the levels of androgens in the prostate

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4
Q

What is the main complication of BPH?

A

Gradual compression of the prostatic urethra causing urinary tract obstruction

=> 2 components underlying the development of obstruction:

  • Increased tone of smooth muscle in the prostate, making the organ contract around the urethra
  • Mechanical effect due to the physical bulk of the prostate
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5
Q

What are the affects on the bladder when BPH causes obstruction?

A
  • To overcome the higher pressure in the urethra, the bladder undergoes compensatory hypertrophy, seen as trabeculations
  • Eventually, detrusor muscle of bladder decompensates, causing the bladder to dilate until it is converted to a big flabby sac with little power to contract
  • Patients with CHRONIC urinary retention have an enlarged palpable bladder which is PAINLESS
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6
Q

What is the main distinguishing factor between acute and chronic urinary retention?

A

ACUTE urinary retention is PAINFUL

CHRONIC urinary retention is PAINLESS

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7
Q

What are the complications that occur if bladder outflow obstruction is not relieved?

A

Hydroureter and Hydronephrosis bilaterally

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8
Q

What is the name given for renal dysfunction as a result of obstruction of urine flow?

A

Obstructive uropathy

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9
Q

What is the clinical presentation of BPH?

A
  • Lower urinary tract symptoms (frequency, urgency, nocturia, hesitancy, poor flow and terminal dribbling)
  • Acute urinary retention
  • UTI due to stasis
  • Obstructive uropathy
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10
Q

What are the risk factors of prostate cancer?

A
  • Age
  • Afro Caribbean origin
  • Germline BRCA mutations
  • Lynch Syndrome (HNPCC)
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11
Q

What are the two types of prostate cancer?

A

=> Latent Prostate Cancer

  • Asymptomatic
  • Typical scenario is an male in his 50s 60s asking his GP for PSA test
  • PSA levels are elevated so prostate biopsy is done
  • Prostate cancer revealed

=> Symptomatic Prostate Cancer

  • Symptoms occur as a result of the primary tumour or due to the effects of metastases
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12
Q

What are the symptoms of prostate cancer?

A

=> Symptoms due to metastases occur first:

  • Persistent back pain due to metastases to vertebral bones

=> Symptoms due to local disease present later:

  • Bladder outflow obstruction
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13
Q

What cancers are most likely to metastasise to bone?

A
  • Breast
  • Lung
  • Prostate
  • Kidney
  • Thyroid

=> Prostate cancer metastases are osteosclerotic

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14
Q

What is the pathophysiology of prostate cancer?

A
  • Adenocarcinomas arising from epithelial cells

- The asymptomatic premalignant lesion is known as Prostatic Intraepithelial Neoplasia (PIN)

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15
Q

What are the investigations in suspected prostate cancer?

A

=> Gold Standard - Transrectal Ultrasound guided biopsy

  • Biopsy taken from 12 areas within the gland
  • The biopsy shows the tumour composed of numerous round acinar
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16
Q

What grading system is used in prostate cancer?

A

Gleason Scoring System

17
Q

What staging system is used in prostate cancer?

A

TNM

18
Q

What is the management of Latent Prostate Cancer?

A

=> Radical Protatectomy

  • Complete removal of prostate
  • Side effects include urinary incontinence, erectile dysfunction, bladder neck obstruction and death

=> Radical radiotherapy:

  • Given as external beam therapy or brachytherapy
  • Brachytherapy involves placing radioactive seeds into the prostate
  • Side effects include urinary incontinence, erectile dysfunction, long term bowel and bladder problems

=> Active surveillance

  • Used on patients that have a low risk of the cancer causing problems
  • Suitable for active surveillance if PSA low, gleason score 3+3, only small proportion of 12 biopsies contain cancer
19
Q

What is the management of Active Prostate Cancer?

A

=> Androgen deprivation:

  • Surgical castration (bilateral orchidectomy)
  • Pharmacological (anti androgens)

Urology (5 decks)

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