BPH and Prostatic Ca Flashcards
Benign prostatic hyperplasia (BPH) is defined as the benign enlargement of the prostate in the X zone. What is X?
What zones are typically enlarged in prostate cancer? List them in order of incidence
BPH -> Transitional zone
Prostate Ca:
1) Peripheral zone (70%)
2) Transitional zone (20%)
3) Centra zone (10%)
What symptoms would you like to elicit when taking a history from a patient with an enlarged prostate
What scoring system is best to assess for BPH? (including what it stands for)
Go through it like you would for a long case including how to interpret the results
What bedside and labs will you order for a patient with an enlarged prostate?
I know that PSA has very poor specificity. In what cases would the PSA be correctly and falsely elevated?
What is an important reason it may be reduced and mask a diagnosis? (first class)
Correctly elevated: increasing age, prostate cancer, BPH
Falsely elevated: Exercise, UTI, Prostate biopsy/instrumentation, Catheter insertion, Post-DRE, ejaculation, Acute urinary retention!
Finasteride or Dutasteride reduces PSA by approx. 50% => patient on it for BPH may not miss the cancer
What should be done first, blood for PSA or DRE?
PSA first as DRE will falsely elevate PSA
Who gets their PSA checked? How often?
Men >50 or afrocarribean/family history >40
What are the correct ranges for a positive PSA test worth referral for the following age brackets
50+
60+
70+
For prostate cancer, what level of PSA would indicate that there is a high chance of spread?
Remember when we are looking at PSA results its the trend that is important and not the number
50+: >3
60+: >4
70+: >5
PSA>40 indicates high chance of spread. >100 means very likely metastatic spread has already occurred
You have performed the history, exam, and labs for a patient with suspected prostate pathology. Tell me the steps that are left to escalate to before reaching the stage of treatment.
You perform a DRE on a patient with a suspected enlarged prostate. What findings are you looking for and what would they indicate?
BPH - Smooth and soft enlargement of the prostate (transitional zone)
Prostate Ca - Firm, irregular (probably peripheral zone)
You have just performed the multiparametric MRI Prostate. What score comes back to you? What would warrant escalation?
PIRADS score
Score out of 5 like every other cancer. 3 requires followup, 4 and 5 require escalation to Biopsy
Youre in the long case and youve supposedly taken a biopsy. What score comes back? explain it
What is the full algorithm of investigations for a patient presenting with urinary symptoms and a history of prostate cancer in the family?
What is the conservative management of BPH? Who should receive this management approach?
The TNM staging is pretty easy for prostate Ca. What is it?
Go through the medical management of BPH
Extra things to add:
1) MOA
2) SE of first line medication
What is TUR syndrome?
What signs may indicate this?
How is it prevented and treated?
Glycine is a hypotonic solution that is continuously irrigated during surgery via prostate venous sinus. This causes hypervolemia, HTN, hyponatramia and confusion (presents like Conn’s but acute)
Prevention:
Reduce surgery time <1hr
Reduce fluid pressure
Use saline instead (like in TUVP)
Treatment: Diuresis + fluid restriction
Surgery and medical therapy ended up having similar outcomes based on multiple studies. there are risks and benefits to each. What are the specific complications of prostate surgery that you should inform the patient when making the decision alongside them?
Note: Same apply to prostate cancer surgery obviously
There are a bunch of procedures for BPH for those who have complications despite medical therapy. Give as many surgical options as you can.
Extra:1 phrase to explain the procedure (most are in the name)
1 in 7 men will have prostate cancer. What gene is associated with it?
BRCA like breast
80% of men over 80 have prostate cancer, moreso in the afrocarribean population. What is the most common type of prostate cancer?
Almost all are Adenocarcinoma
Without going into detail what approaches and treatment options do we have for prostate cancer?
Most patients will not die from prostate cancer => Surveillance
Treatment
1) Surgery
2) +/-Radiotherapy and Brachytherapy
3) +/- ADT- Androgen deprivation therapy
You bring up the options for managing a patient with prostate cancer in the long case and begin with surveillance. Go ahead and explain it (more = better)
What surgery is performed for prostate cancer?
What is involved in the surgery?
What stages are these appropriate for?
T1/T2 but not LN or mets
Androgen deprivation therapy can be medical or surgical as an adjuvant or standalone therapy.
What is the medical option and the main side effects if this is chosen
What is the surgical option for androgen deprivation therapy?
Discuss the management of prostate cancer as you would in a long case
