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Peri-op > BPH, Prostatitis and Prostate Cancer > Flashcards

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
Q

List 4 complications of acute bacterial prostatitis?

A
  1. Sepsis
  2. Prostate abscess
  3. Acute urinary retention
  4. Chronic prostatitis
26
Q

What are the 2 most common locations which prostate cancer spreads?

A
  1. Lymph nodes
  2. Bones
27
Q

What is meant by androgen-dependent feature of prostate cancer?

A

Relies on androgen hormones (testosterone) to grow

28
Q

What type of cancer are the majority of prostate cancers

A

Adenocarcinomas

29
Q

What are the 3 zones of the prostate?

A
  1. Transitional
  2. Peripheral
  3. Central
30
Q

What is the most common zone where prostate cancer grows?

A

The peripheral zone

31
Q

List 4 risk factors for prostate cancer?

A
  1. Increasing age
  2. Family history
  3. Black African or Caribbean origin
  4. Tall stature
  5. Anabolic steroids
32
Q

How does prostate cancer present?

A
  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
Q

What is the reliability of PSA?

A

High rate of false positives (75%) and false negatives (15%)

34
Q

In the UK, men > 50 can request a PSA test, what counselling would you give your patient?

A

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
Q

List 4 causes of a raised PSA?

(DAVE)

A
  1. DRE
  2. Anal sex
  3. Vigorous exercise
  4. Ejaculation
  5. Prostate cancer, BPH, Prostatitis
  6. UTIs
36
Q

Findings on DRE of a BPH

A

Smooth, symmetrical and slightly soft, with a maintained central sulcus

Nay be generalised enlargement (hyperplasia)

37
Q

Findings on DRE of a Prostatitis

A

Enlarged, tender and warm

38
Q

Findings on DRE of a cancerous prostate

A

Firm or hard, asymmetrical, craggy or irregular, with loss of the central sulcus.

May be a hard nodule

39
Q

First-line investigation for suspected localised prostate cancer?

Interpret the findings?

A

Multiparametric MRI

  • 1 – very low suspicion
  • 2 – low suspicion
  • 3 – equivocal
  • 4 – probable cancer
  • 5 – definite cancer
40
Q

When is a prostate biopsy recommended?

A

MRI findings (3 or above) and the clinical suspicion (DRE and PSA level)

41
Q

How accurate are prostate biopsies?

A

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
Q

2 options for prostate biopsies?

A
  1. Transrectal ultrasound-guided biopsy (TRUS)
  2. Transperineal biopsy
43
Q

List 4 risks of a prostate biopsy?

A
  1. Pain
  2. Bleeding
  3. Infection
  4. Urinary retention due to short term swelling
  5. Erectile dysfunction (rare)
44
Q

How can we asses for bony metastasis?

A

Isotope Bone Scan (aka radionuclide scan or bone scintigraphy)

45
Q

What grading system is used for prostate cancer?

A

Gleason Grading System

  • Based on histology from biopsies
  • Helps determine appropriate treatment
46
Q

How is the Gleason score calculated?

A

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
Q

Interpret the various Gleason scores

A
  • 6 is low risk
  • 7 is intermediate risk
  • 8 + is high risk
48
Q

What staging system is used for prostate cancer?

A

TNM staging

49
Q

Management of prostate cancer?

A
  • Surveillance or watchful waiting in early cancer
  • External beam radiotherapy
  • Brachytherapy
  • Hormone therapy
  • Surgery
50
Q

What is a key complication of external beam radiotherapy?

A

Proctitis

Can cause pain, altered bowel habit, rectal bleeding and discharge

Prednisolone suppositories can help reduce inflammation

51
Q

List 3 hormone therapies used for prostate cancer?

A
  • Androgen-receptor blockers eg. Bicalutamide
  • GnRH agonists such as Goserelin
  • Bilateral orchidectomy
52
Q

List 4 side effects of hormone therapy

A
  1. Hot flushes
  2. Sexual dysfunction
  3. Gynaecomastia
  4. Fatigue
  5. Osteoporosis
53
Q

List 2 complications of a Radical prostatectomy

A
  1. Erectile dysfunction
  2. Urinary incontinence
54
Q

To who is active surveillance for prostate cancer offered?

A

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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