BPH, Prostate cancer Flashcards
Pathophysiology of BPH
Inner (transitional layer of prostate affected)
5α-reducatase converts testosterone to DHT
Increased DHT causes hyperplasia
Presentation of BPH
Storage symptoms
Voiding symptoms
Bladder stones
UTI
Storage symptoms
Nocturia
Frequency
Urgency
Overflow incontinence
Voiding symptoms
Hesitancy
Poor stream
Terminal dribbling
Incomplete emptying
Pis en deux
Pis en deux
residual urine results in a desire to pass urine soon after voiding
PR findings for BPH
Smoothly enlarged prostate
Definable median sulcus
Ix for BPH
U+Es, PSA
Urine dip and MCS
Transrectal US +/- biopsy
Urodynamics
Conservative Mx of BPH
Reduce caffeine and EtOH
Double voiding
Bladder training
Medical Mx of BPH
1st) Tamsulosin - α-blockers, relax smooth muscle
2nd) Finasteride - 5α-reducatase inhibitor
Side effects of tamsulosin
Drowsiness
Hypotension
Depression
Weight gain
Side effects of finasteride
Erectile Dysfunction
Excreted in semen (use condoms)
Surgical Mx of BPH
TURP, TUIP
Laser prostatectomy
Open retropubic prostatectomy
TUIP
Transurethral Incision of Prostate
Advantages of TUIP over other methods
less risk to sexual funtion
Immediate TURP complications
Haemorrhage
TURP syndrome
TURP syndrome
large fluid absorption leading to hyponatraemia
Early TURP complications
Haemorrhage
Infection
Clot retention
Late TURP complications
Retrograde ejaculation
ED
Incontinence
Urethral stricture
Recurrence
Race with higher incidence of prostate cancer
Black
Pathology of prostate cancer
Adenocarcinoma
Peripheral zone of prostate
Presentation of prostate cancer
Usually asymptomatic
Mets: bone pain
Storage/Voiding Sx
PR findings of prostate cancer
Hard irregular/craggy prostate
Loss of midline sulcus
Common metastasis sites of prostate cancer
Bone
Rectum
Liver
Lung
Ix for prostate cancer
PSA, U+Es ALP
CXR
Bone scan
Transrectal US +/- biopsy
Gleason grading system
Used to grade prostate cancer
Gleason score = Most common cell morphology + Second most common cell morphology
Prostate cancer staging Tis
Carcinoma in situ
Prostate cancer staging T1
Incidental finding on TURP or raised PSA
Prostate cancer staging T2
Intracapsular tumour with prostate deformation
Prostate cancer staging T3
Extra-prostatic extension
Prostate cancer staging T4
Fixed to pelvis + invading neighbouring structures
Conservative Mx of prostate cancer
Monitoring with PR and PSA
Who is suitable for prostate cancer medical mx
Used for metastatic or node +ve disease
Medical Mx of prostate cancer
Goserelin
Tamsulosin
Finesteride
Goserelin mech of action
LHRH analogue, reduces testosterone
Surgical Mx of prostate cancer
Radical Prostatectomy - robot laproscopically
Symptomatic management of prostate cancer
TURP for obstruction
Analgesia
Radiotherapy for bone mets / cord compression
