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BPH, Prostatitis and Prostate Cancer Flashcards

1
Q

List 2 key risk factors for BPH?

A
  1. age
  2. ethnicity: black > white > Asian
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2
Q

How does BPH present?

A

LUTS:

  • Hesitancy
  • Weak flow
  • Urgency
  • Frequency
  • Intermittency
  • Straining
  • Terminal dribbling
  • Incomplete emptying
  • Nocturia
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3
Q

What scoring system can be used to assess the severity of LUTS

A

The international prostate symptom score (IPSS)

  • 20–35: severely symptomatic
  • 8–19: moderately symptomatic
  • 0–7: mildly symptomatic
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4
Q

What is included in the initial assessment of men presenting with LUTS?

A
  1. DRE
  2. Abdo exam
  3. Urinary frequency volume chart, recording 3 days of fluid intake and output
  4. Urine dipstick
  5. PSA
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5
Q

Is PSA sensitive or specific?

A

Sensitive (90%)

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6
Q

List 4 causes of raised PSA?

(DAVE)

A
  1. DRE
  2. Anal sex
  3. Vigorous exercise
  4. Ejaculation
  5. Prostate cancer, BPH, Prostatitis
  6. UTIs
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7
Q

Compare the examination findings of a benign vs cancerous prostate on DRE

A

Benign feels smooth, symmetrical and slightly soft, with a maintained central sulcus

Cancerous may feel firm/hard, asymmetrical, craggy or irregular, with loss of the central sulcus

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8
Q

First line medication for BPH

A
  • Alpha blockers eg. Tamsulosin
  • Indicated for voiding symptoms (IPSS ≥ 8)
  • Acts to relax smooth muscle

*May be used in combination with Finasteride

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9
Q

What is an important side effect of alpha-blockers like tamsulosin?

A

Postural hypotension

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10
Q

What medication may be indicated if there is significant prostate enlargement or high risk of progression?

A
  • 5 alpha-reductase inhibitors eg. Finasteride
  • Blocks conversion of testosterone to DHT (known to induce BPH)
  • Reduces size of prostate
  • Symptoms may not improve for 6 months
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11
Q

Most common side effect of finasteride?

A

Sexual dysfunction (due to reduced testosterone)

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12
Q

List a surgical options for BPH

A
  1. TURP
  2. Transurethral electrovaporisation of the prostate (TEVAP/TUVP)
  3. Holmium laser enucleation of the prostate (HoLEP)
  4. Open prostatectomy
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13
Q

List 4 side effects of TURP

A
  1. Bleeding
  2. Infection
  3. Incontinence
  4. Erectile dysfunction
  5. Retrograde ejaculation
  6. Urethral strictures
  7. Failure to resolve symptoms
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14
Q

What is Prostatitis?

A

Inflammation of the prostate

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15
Q

How can Prostatitis be classified?

Compare these

A

Acute bacterial prostatitis – acute infection in the prostate, presenting with a more rapid onset of symptoms

Chronic prostatitis – symptoms lasting for at least 3 months

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16
Q

How may chronic prostatitis be sub-divided?

A
  1. Chronic prostatitis or chronic pelvic pain syndrome (no infection)
  2. Chronic bacterial prostatitis (infection)
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17
Q

How does chronic prostatitis present?

A

At least 3 months of:

  • Pelvic pain
  • LUTS
  • Sexual dysfunction
  • Pain with bowel movements
  • Tender and enlarged prostate on exam
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18
Q

How does Acute bacterial prostatitis present?

A

More acute presentation with similar symptoms to chronic prostatitis +/- systemic symptoms such as:

  • Fever
  • Myalgia
  • Nausea
  • Fatigue
  • Sepsis
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19
Q

What online scoring tool for prostatitis is used to assess severity of symptoms and impact on quality of life

A

National Institute of Health Chronic Prostatitis Symptom Index

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20
Q

Investigations for chronic prostatitis?

A
  1. Urine dipstick
  2. Urine microscopy, culture and sensitivities
  3. Chlamydia and gonorrhoea NAAT testing on a first pass urine, if suspected STI
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21
Q

Management of acute bacterial prostatitis?

A
  • 14-day course of a quinolone
  • Analgesia
  • Laxatives for pain during bowel movements
  • Hospital admission if systemically unwell or septic
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22
Q

Management of chronic prostatitis?

A
  • Alpha-blockers (eg. Tamsulosin)
  • Trimethoprim or doxycycline if < 6 months or history of infection
23
Q

What is the analgesia of choice for prostatitis (acute or chronic)

A

Paracetamol or NSAIDs

24
Q

What Psychological treatments may be offered for chronic prostatitis?

A

CBT and/or Antidepressants

25
List 4 complications of acute bacterial prostatitis?
1. Sepsis 2. Prostate abscess 3. Acute urinary retention 4. Chronic prostatitis
26
What are the 2 most common locations which prostate cancer spreads?
1. Lymph nodes 2. Bones
27
What is meant by androgen-dependent feature of prostate cancer?
Relies on androgen hormones (testosterone) to grow
28
What type of cancer are the majority of prostate cancers
Adenocarcinomas
29
What are the 3 zones of the prostate?
1. Transitional 2. Peripheral 3. Central
30
What is the most common zone where prostate cancer grows?
The peripheral zone
31
List 4 risk factors for prostate cancer?
1. Increasing age 2. Family history 3. Black African or Caribbean origin 4. Tall stature 5. Anabolic steroids
32
How does prostate cancer present?
1. Asymptomatic 2. LUTS (hesitancy, frequency, weak flow, terminal dribbling and nocturia) 3. Haematuria, erectile dysfunction Advanced disease or metastasis → weight loss, bone pain or CES
33
What is the reliability of PSA?
High rate of false positives (75%) and false negatives (15%)
34
In the UK, men \> 50 can request a PSA test, what counselling would you give your patient?
Benefits: * Early detection and effective treatment of prostate cancer Negatives: * False positives may lead to unnecessary further investigations ie. invasive biopsies, which have complications + unnecessary diagnosis and treatment that would never have caused problem * False negatives may lead to false reassurance
35
List 4 causes of a raised PSA? (DAVE)
1. DRE 2. Anal sex 3. Vigorous exercise 4. Ejaculation 5. Prostate cancer, BPH, Prostatitis 6. UTIs
36
Findings on DRE of a BPH
Smooth, symmetrical and slightly soft, with a maintained central sulcus Nay be generalised enlargement (hyperplasia)
37
Findings on DRE of a Prostatitis
Enlarged, tender and warm
38
Findings on DRE of a cancerous prostate
Firm or hard, asymmetrical, craggy or irregular, with loss of the central sulcus. May be a hard nodule
39
First-line investigation for suspected localised prostate cancer? Interpret the findings?
Multiparametric MRI * 1 – very low suspicion * 2 – low suspicion * 3 – equivocal * 4 – probable cancer * 5 – definite cancer
40
When is a prostate biopsy recommended?
MRI findings (3 or above) and the clinical suspicion (DRE and PSA level)
41
How accurate are prostate biopsies?
Risk of false-negatives if the biopsy misses the cancerous area Multiple needles are used to take samples from different areas, MRI results can guide the biopsy
42
2 options for prostate biopsies?
1. Transrectal ultrasound-guided biopsy (TRUS) 2. Transperineal biopsy
43
List 4 risks of a prostate biopsy?
1. Pain 2. Bleeding 3. Infection 4. Urinary retention due to short term swelling 5. Erectile dysfunction (rare)
44
How can we asses for bony metastasis?
Isotope Bone Scan (aka radionuclide scan or bone scintigraphy)
45
What **grading** system is used for prostate cancer?
Gleason Grading System * Based on histology from biopsies * Helps determine appropriate treatment
46
How is the Gleason score calculated?
Made up of **two numbers** added together for the total score: 1. Grade of the most prevalent pattern in the biopsy 2. Grade of the second most prevalent pattern in the biopsy
47
Interpret the various Gleason scores
* 6 is low risk * 7 is intermediate risk * 8 + is high risk
48
What **staging** system is used for prostate cancer?
TNM staging
49
Management of prostate cancer?
* Surveillance or watchful waiting in early cancer * External beam radiotherapy * Brachytherapy * Hormone therapy * Surgery
50
What is a key complication of external beam radiotherapy?
**Proctitis** Can cause pain, altered bowel habit, rectal bleeding and discharge Prednisolone suppositories can help reduce inflammation
51
List 3 hormone therapies used for prostate cancer?
* Androgen-receptor blockers eg. Bicalutamide * GnRH agonists such as Goserelin * Bilateral orchidectomy
52
List 4 side effects of hormone therapy
1. Hot flushes 2. Sexual dysfunction 3. Gynaecomastia 4. Fatigue 5. Osteoporosis
53
List 2 complications of a Radical prostatectomy
1. Erectile dysfunction 2. Urinary incontinence
54
To who is active surveillance for prostate cancer offered?
Clinical stage T1c Gleason score 3+3 PSA density \< 0.15 ng/ml/ml who have cancer in less than 50% of their biopsy cores, with \< 10 mm of any core involved

Peri-op (22 decks)

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