BPH and prostate carcinoma

Question 1

Most common type of prostate carcinoma

Answer 1

Acinar adenocarcinoma

Adeno= glandular cells

Question 2

BPH key symptoms

Answer 2

Weak flow
Terminal dribbling
Incomplete emptying
Urgency and frequency
UTI

Question 3

Prostate carcinoma symptoms

Answer 3

Usually asymptomatic 
Lower back or bone pain
Lethargy
ED
Anorexia and weight loss

Question 4

Where does prostate cancer usually spread

Answer 4

Bone

Question 5

DRE: findings on BPH vs prostate cancer

Answer 5

BPH= enlarged but smooth and firm like normal

Prostate cancer= hard, nodular, loss median sulcus

Question 6

PSA level in cancer

Answer 6

> 3

Question 7

BPH management

Answer 7

Waiting
a-1 antagonist eg tamsulosin
5 a-reductase inhibitors eg finasteride

Question 8

What type of drugs are tamsulosin and alfuzosin

Answer 8

a-1 antagonist

Question 9

What type of drug is finasteride

Answer 9

5-a reductase inhibitor

Question 10

What is the MOA of 5-a reductase inhibitor

Answer 10

Block conversion of testosterone to dihydrotestosterone (DHT) which is known to induce BPH (basically DHT –> BPH, so decrease DHT production)

Question 11

What type of drug is Goserelin (Zoladex)

Answer 11

GnRH Agonist

Question 12

Pathophys of BPH

Answer 12

Testosterone–> DHT–> androgen receptors on stromal AND epithelial cells–> release growth factors (FGF and TGF-beta)–> proliferation of stromal cells and dec apoptosis of epithelial cells

Question 13

What zone of prostate are most cancers in

Answer 13

Peripheral

Question 14

What is the scoring system for prostate cancer?

Answer 14

Gleason
Assign one Gleason grade to the most predominant pattern in biopsy and second grade to second most predominant pattern. 2 grades added together to determine score. Theoretically, Gleason scores range from 2-10. However, pathologists almost never assign scores 2-5, and Gleason scores assigned will range from 6 to 10, with 6 being the lowest grade cancer.