BPH, Prostate cancer

Question 1

Pathophysiology of BPH

Answer 1

Inner (transitional layer of prostate affected)

5α-reducatase converts testosterone to DHT

Increased DHT causes hyperplasia

Question 2

Presentation of BPH

Answer 2

Storage symptoms

Voiding symptoms

Bladder stones

UTI

Question 3

Storage symptoms

Answer 3

Nocturia

Frequency

Urgency

Overflow incontinence

Question 4

Voiding symptoms

Answer 4

Hesitancy

Poor stream

Terminal dribbling

Incomplete emptying

Pis en deux

Question 5

Pis en deux

Answer 5

residual urine results in a desire to pass urine soon after voiding

Question 6

PR findings for BPH

Answer 6

Smoothly enlarged prostate

Definable median sulcus

Question 7

Ix for BPH

Answer 7

U+Es, PSA

Urine dip and MCS

Transrectal US +/- biopsy

Urodynamics

Question 8

Conservative Mx of BPH

Answer 8

Reduce caffeine and EtOH

Double voiding

Bladder training

Question 9

Medical Mx of BPH

Answer 9

1st) Tamsulosin - α-blockers, relax smooth muscle
2nd) Finasteride - 5α-reducatase inhibitor

Question 10

Side effects of tamsulosin

Answer 10

Drowsiness

Hypotension

Depression

Weight gain

Question 11

Side effects of finasteride

Answer 11

Erectile Dysfunction

Excreted in semen (use condoms)

Question 12

Surgical Mx of BPH

Answer 12

TURP, TUIP

Laser prostatectomy

Open retropubic prostatectomy

Question 13

TUIP

Answer 13

Transurethral Incision of Prostate

Question 14

Advantages of TUIP over other methods

Answer 14

less risk to sexual funtion

Question 15

Immediate TURP complications

Answer 15

Haemorrhage

TURP syndrome

Question 16

TURP syndrome

Answer 16

large fluid absorption leading to hyponatraemia

Question 17

Early TURP complications

Answer 17

Haemorrhage

Infection

Clot retention

Question 18

Late TURP complications

Answer 18

Retrograde ejaculation

ED

Incontinence

Urethral stricture

Recurrence

Question 19

Race with higher incidence of prostate cancer

Answer 19

Black

Question 20

Pathology of prostate cancer

Answer 20

Adenocarcinoma

Peripheral zone of prostate

Question 21

Presentation of prostate cancer

Answer 21

Usually asymptomatic

Mets: bone pain

Storage/Voiding Sx

Question 22

PR findings of prostate cancer

Answer 22

Hard irregular/craggy prostate

Loss of midline sulcus

Question 23

Common metastasis sites of prostate cancer

Answer 23

Bone

Rectum

Liver

Lung

Question 24

Ix for prostate cancer

Answer 24

PSA, U+Es ALP

CXR

Bone scan

Transrectal US +/- biopsy

Question 25

Gleason grading system

Answer 25

Used to grade prostate cancer

Gleason score = Most common cell morphology + Second most common cell morphology

Question 26

Prostate cancer staging Tis

Answer 26

Carcinoma in situ

Question 27

Prostate cancer staging T1

Answer 27

Incidental finding on TURP or raised PSA

Question 28

Prostate cancer staging T2

Answer 28

Intracapsular tumour with prostate deformation

Question 29

Prostate cancer staging T3

Answer 29

Extra-prostatic extension

Question 30

Prostate cancer staging T4

Answer 30

Fixed to pelvis + invading neighbouring structures

Question 31

Conservative Mx of prostate cancer

Answer 31

Monitoring with PR and PSA

Question 32

Who is suitable for prostate cancer medical mx

Answer 32

Used for metastatic or node +ve disease

Question 33

Medical Mx of prostate cancer

Answer 33

Goserelin

Tamsulosin

Finesteride

Question 34

Goserelin mech of action

Answer 34

LHRH analogue, reduces testosterone

Question 35

Surgical Mx of prostate cancer

Answer 35

Radical Prostatectomy - robot laproscopically

Question 36

Symptomatic management of prostate cancer

Answer 36

TURP for obstruction

Analgesia

Radiotherapy for bone mets / cord compression