Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Infectious disease, Oncology, & Urology > BPH & Prostate Cancer > Flashcards

BPH & Prostate Cancer Flashcards

1
Q

What does BPH stand for?

What about BPO?

A

Benign prostatic hyperplasia

Benign prostatic obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hyperplasia vs hypertrophy?

A

Hyperplasia is when there are more cells present

Hypertrophy is when the size of the cells increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pathophysiology of BPH?

A

Increase in size of prostate because of hyperplasia

Normal with advancing age

Caused by presence of testosterone

Likely to be caused by failure of apoptosis

Results in compression and eventual obstruction of the prostatic urethra (called BPO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical features of BPH?

A

Lower urinary tract symptoms

Storage symptoms:

  • Urinary frequency
  • Urgency
  • Nocturia
  • Incontinence (urge and stress)

Voiding symptoms:

  • Hesitancy
  • Poor stream
  • Intermittency
  • Terminal dribbling
  • Retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Investigations of BPH?

A

Bedside:

  • Obs
  • Abdominal examination (feel for palpable bladder)
  • DRE
  • Urine dip

Routine:

  • Bloods: FBC, UE, LFTS (bone mets), PSA
  • Abdominal XR
  • Urinalysis
  • Post-void residual bladder volume USS
  • USS KUB

Specialist:

  • Flow rate assessment
  • Flexible cystoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Differential diagnosis of lower urinary tract symptoms?

A 
UTI
BPH
Prostate cancer
Bladder cancer
Detrusor instability
Urethral structures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What would you find on a PR exam in a patient with BPH?

A

Enlarged, smooth prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of BPH?

A

Conservative:

  • reduce caffeine intake
  • stop diuretics if can
  • advise they take diuretics in morning to lessen nocturia

Medical:

  • alpha blockers (tamsulosin)
  • 5 alpha-reductase inhibitors

Surgical:
- transurethral resection of prostate (coring out middle of prostate gland)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe what drugs are used to manage BPH and how they work?

A

Alpha blockers

  • tamsulosin, doxazosin
  • alpha 1 receptor
  • these relax the smooth muscle of the prostate reducing constriction of urethra

5-alpha-reductase inhibitors

  • finasteride
  • stop conversion of testosterone to more potent form dihydrotestosterone which drives hyperplasia
  • reduces size of prostate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What’s the name of the potent form of testosterone?

What converts testosterone to this?

A

Dihydrotestosterone

Converted by 5-alpha reductase enzyme

Hence why 5-alpha reductase drugs are used to treat BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What receptors do tamsulosin and doxazosin act on?

Where else are these receptors found?

What are side effects of these drugs?

A

Alpha-1

Arteries - cause vasoconstriction
Smooth muscle
CNS

Low BP because of blockade of alpha receptors preventing vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Acute vs chronic urinary retention?

A

Acute is sudden onset. When the bladder is full but NO urine is being passed at all - there is complete obstruction.
Causes bladder distension and pain.

Chronic retention is increased residual volume of urine. They may still pass urine but experience LUTS. No pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical features of chronic urinary retention?

A

LUTS, for a long period of time (not acutely)

Storage

  • urgency
  • incontinence
  • frequency
  • nocturia

Voiding

  • Unable to void
  • Poor stream
  • Hesitancy
  • Terminal dribbling
  • Intermittency
  • Incomplete emptying of bladder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Complications of chronic urinary retention?

A

Acute retention

Infection

Hydronephrosis due to back pressure of kidneys resulting in AKI or CKD

Overflow incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clinical features of acute urinary retention?

A

Sudden onset

Tender, distended bladder

Unable to pass urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Complications of acute urinary retention?

A

UTI
AKI due to backflow
Rupture

Post-obstructive diuresis, haematuria

17
Q

Causes of acute vs chronic urinary retention?

A

Acute:

  • BPH
  • Prostate cancer
  • bladder calculi
  • bladder cancer
  • prolapse
  • gynae pelvic mass (ovarian cyst, fibroid)
  • cauda equina

Chronic:

  • BPH
  • Prostate cancer
  • Drugs
  • Congenital deformities
  • Urethral strictures
18
Q

Which drugs cause urinary retention?

A

Anti-histamines

Anti-cholinergics

  • TCAs
  • tiotropium
  • oxybutinin

Anti-spasmodics

19
Q

What can cause urethral strictures?

A

Infection: STI, TB

Trauma: pelvic fracture

20
Q

Which region of the prostate is affected in BPH?

A

Transitional zone, which surrounds the urethra

21
Q

Which type of cancer is prostate cancer usually?

Which region of prostate is usually affected?

A

Adenocarcinoma (arising from glandular cells)

Peripheral zone

22
Q

What can cause PSA level to rise?

A 
BPH
Prostate cancer
UTI
Prostatitis
Ejaculation
Prostate injury
Age
23
Q

Clinical features of prostate cancer?

A

LUTS which progress faster than BPH symptoms

Erectile dysfunction

Weight loss, anorexia

Signs of mets: back pain, bone lesions, derranged LFTs

PR exam: hard craggy prostate

24
Q

Investigations of prostate cancer?

A

Rule out infection (urine dip)

PR exam: hard craggy prostate

PSA

Transrectal USS (TRUSS) and biopsy

Urinalysis: PCA3 (a genetic marker)

Imaging: CT

25
Q

In suspected prostate cancer, why do you do these tests?

  • U+E
  • LFTs
  • CT/MRI
  • Bone scan
A

U+E: to check renal function in case of hydronephrosis cause by obstruction

LFTs: liver and bone mets

CT/MRI: to stage

Bone scan: to stage and look for bone mets

26
Q

Which LFT will tell you if there might be bone mets?

A

Alkaline phosphatase

27
Q

How is prostate cancer staged?

A

TNM

T1 found histologically only

T2: palpable tumour that has not spread beyond prostate capsule

T3: tumour spread through capsule to the seminal vesicles, prostate is mobile on PR exam

T4: tumour has spread to pelvic wall and organs, it is non mobile on PR exam

28
Q

Management of prostate cancer?

A

T1-T2

  • active surveillance
  • radical prostatectomy
  • radical radiotherapy
  • brachytherapy

T3-T4

  • combination of androgen deprivation therapy and radiotherapy
  • or watchful waiting
29
Q

What’s the difference between active surveillance and watchful waiting?

A

BOTH:

  • For men whose cancer isn’t causing problems or symptoms currently.
  • To avoid unnecessary treatment

Active surveillance:

  • men with localised cancer
  • well enough to have surgery and radiotherapy if needed
  • Treatment (if given) would be to cure.
  • Monitored regularly with biopsies and MRI.

Watchful waiting

  • Men with health problems affecting ability to cope with surgery and radiotherapy
  • And men whose cancer may never affect them (because other problems will first)
  • Fewer tests, and check ups at GP.
30
Q

A 55 year old man has stage T2 prostate cancer found incidentally.

He is fit and well.

Would you put him on watchful waiting or active surveillance?

A

Active surveillance

He is asymptomatic so it is good to avoid treatment that’s not necessary at the moment.

He is well so would be able to cope with invasive monitoring and treatment.

31
Q

A 87 year old man has stage T2 prostate cancer found incidentally.

He has CCF leaving him unable to walk more than a few metres without being SOB.

Would you put him on watchful waiting or active surveillance?

A

Watchful waiting

He is asymptomatic so good to avoid treatment that’s not necessary at the moment.

He has poor exercise tolerance so probably wouldn’t cope well with invasive monitoring and treatment.

Probably his CCF will cause his death before his prostate cancer will.

32
Q

What is brachytherapy?

A

Insertion of radioactive material directly into the affected area.

A high dose of radiation is given to the tumour but not to the healthy tissue.

In prostate cancer, either inserted into the tumour, or into a catheter in the prostate

33
Q

What is meant by androgen deprivation therapy? What types are there? (Don’t describe)

Is it used in metastatic or non-metastatic cancer?

A

The growth of metastatic deposits is driven by testosterone

If the testosterone is removed then growth of mets should slow.

Can be done medically or surgically

34
Q

How does medical androgen deprivation therapy work?

A

GnRH analogues, specifically LH releasing hormone

Work in the same way as the ones used to put a woman into medical menopause (for endometriosis, fibroids)

The excess LH (after some time) causes downregulation of LH receptors on the testes

They stop producing testosterone

Low testosterone reduces growth of mets

35
Q

How does surgical androgen deprivation therapy work?

A

Orchidectomy

removal of testicles

36
Q

What are complications of TURP?

A

Bleeding

TURP syndrome: irrigation fluid is absorbed into circulation via cut veins

Indwelling catheter needed until bleeding stopped

Urethral structure
Retrograde ejactulation
ED

37
Q

Clinical features of TURP syndrome?

A

CNS: restlessness, headache

N+V

Bradycardia
Hypo or hypertension
Tachypnoea
Hypoxia

Hypothermia

Infectious disease, Oncology, & Urology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions