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Urinary > Disease of the Prostate > Flashcards

Disease of the Prostate Flashcards

1
Q

What are the different McNeal zones of the prostate?

A

Transitional zone
Peripheral zone
Central zone
Anterior fibromuscular stroma

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2
Q

Which zone of the prostate is most likely to cause obstruction of urethra?

A

Transition zone

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3
Q

Which zone of the prostate is likely to undergo hypertrophy?

A

Transition zone

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4
Q

Which zone is likely to be felt whilst performing PR examination?

A

Peripheral zone

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5
Q

What does BPE stand for?

A

Benign Prostatic enlargement

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6
Q

What does BPH stand for?

A

Benign prostatic hyperplasia (pathological finding)

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7
Q

What does BPO stand for?

A

Benign prostatic obstruction (clinical entity)

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8
Q

What does BOO stand for?

A

Bladder outflow obstruction

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9
Q

What does LUTS stand for?

A

Lower urinary tract symptoms

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10
Q

What does the Hald diagram demonstrate?

A

BOO
BPE
LUTS
These 3 can coexist or occur independently

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11
Q

Where does hyperplasia of the prostate usually occur?

A

Transition zone

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12
Q

Will BPH result in BOO?

A

Not always

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13
Q

Why is BPE so common in men over 60 yrs?

A

The prostate gland continues to grow throughout life

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14
Q

What are some obstructive LUTS?

A

Hesitancy
Poor stream
Terminal driblling
Incomplete emptying

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15
Q

What are some storage or irritative LUTS?

A

Frequency
Nocturia
Urgency +/- urge incontinence

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16
Q

What are some of the physical findings on examination of someone with BPE?

A

Palpable bladder

PR examination - enlarged prostate

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17
Q

What is phimosis?

A

Inability to pull foreskin back, becomes tight

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18
Q

What is para-phimosis?

A

When the foreskin is retracted but does not move back (emergency)

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19
Q

When feeling for a prostate what are you assessing?

A

Size
Texture
Consistency
Tenderness

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20
Q

What investigations might you do if suspected BPE?

A 
MSSU 
Flow rate study 
Post-void bladder residual USS
Bloods : PSA & urea, creatinine
Flexible cystoscopy
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21
Q

What are the 2 types of BPO?

A

Uncomplicated

Complicated

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22
Q

What are the treatment options for uncomplicated BPO?

A

Watchful waiting
Alpha blockers
5 alpha reductase inhibitors (combo)

TURP
Prostectomy

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23
Q

What is the main medical treatment for BPO?

A

Alpha blockers

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24
Q

How do alpha blockers mediate action?

A

Cause smooth muscle relaxation of internal urethral sphincter & prostate

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25
Q

What alpha blocker is highly selective?

A

Tamsulosin

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26
Q

What might be one of the side effects of an alpha blocker? Why?

A 
Retrograde ejaculation 
(relaxation of internal urethra sphincter)
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27
Q

What is the action of 5 reductase inhibitors?

A

Prevents the conversion of testosterone to dihydrotestosterone

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28
Q

What effect does 5 redcoats inhibitors have on prostate?

A

Reduces testosterone therefore size of prostate

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29
Q

What does TURP stand for?

A

Transurethral resection of prostate

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30
Q

What is the gold standard surgical treatment for BPO?

A

TURP

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31
Q

What are some of the side effects of TURP?

A

Bleeding
Infection
Retrograde ejaculation

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32
Q

What are some of the complications of BOO?

A 
Acute/ chronic urinary retention 
Urinary incontinence (overflow)
UTI
Bladder stones
Renal failure
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33
Q

What are some options for complicated cases of BOO?

A

Catheterisation

Intermittent self-catheterisaition

34
Q

What is the commonest cause of cancer in men?

A

Prostate cancer

35
Q

What blood test would you perform to test for prostate hypertrophy?

A

PSA

36
Q

What are the main risk factors of prostate cancer?

A

Age
Race (AAs increased risk)
Family history

37
Q

Which zone of the prostate is usually affected with cancer?

A

Peripheral zone

38
Q

Which zone does the urethra extend through?

A

Transition zone

39
Q

What symptoms usually present with prostate cancer?

A

Asymptomatic

40
Q

80% of prostate cancers are said to be ____ therefore have a better prognosis.

A

Localised

41
Q

How are the majority of prostate cancers diagnosed?

A

Through opportunistic PSA testing

42
Q

What is the diagnostic triad of prostate cancer?

A

PSA
Digital rectal examination
TRUS-guided prostate biopsy

43
Q

If a prostate cancer is locally invasive, what are some of the symptoms which might be experienced?

A 
Haematuria
Incontinence
Impotence
Haemospermia
Loin pain or auria
44
Q

Where is the most common area of metastatic spread in prostate cancer?

A

Bone

45
Q

Screening for prostate cancer was proved non beneficial because it lead to ______.

A

Over-treatment

Over-diagnosis

46
Q

Which areas of the population do you target with ad-hoc PSA testing?

A

Older males (urinary problems?)

47
Q

What is PSA?

A

Kallikrein serine protease produced by glands of prostate but can leak into serum

48
Q

What is the normal range for PSA?

A

0-0.4ug/ml

49
Q

Why do levels of PSA increase with age?

A

Prostate gland continues to grow throughout life

50
Q

Other than prostate cancer, what else can cause increased PSA?

A 
UTI
PR examination 
Catheterisation 
Ejaculation
BPH
51
Q

If the level of PSA >10, what is the likelihood of cancer?

A

70%

52
Q

What are the different grades of prostate cancer?

A

Score 3-5

53
Q

What is the Gleason SUM score composed of?

A

Most common histological cell type + the second most common cell type

54
Q

What is the highest/ lowest Gleason score?

A

6

10

55
Q

What investigations may be useful to identify prostate staging?

A 
Digital rectal examination 
PSA
CT scan
MRI
Transrectal US guided biopsy
56
Q

What are some of the main treatments used for localised prostate cancer?

A

Watchful waiting
Radiotherapy (external beam or brachytherapy)

Radical prostatectomy

57
Q

What are some types of hormonal therapy used for metastatic prostate cancer?

A

Bilateral orchidectomy
Chemical castration (LHRH Antagonist)
Oestrogen

58
Q

What are the different stages of prostate cancer/

A 
Localised
Locally advanced (T3-4, N0)
Metastatic (T, N1 or M1)
59
Q

What is the usual presenting sign of testicular cancer?

A

Painless lump

60
Q

What are the lesser common presenting signs of testicular cancer?

A

Inflammed, tender swelling

History of trauma

61
Q

In what population is testicular cancer most common?

A

Young men (3rd decade)

62
Q

What are the main risk factors for testicular cancer?

A

Testicular maldescent
Infertility
Atrophic testis
Previous cancer

63
Q

What are the tumour markers associated with testicular cancer which can be tested for in the blood?

A

AFP (alpha-fetoprotein)
bHCG (Human chorionic gonadotrophin)
LDH (lactate dehydrogenase)

64
Q

What are the differential diagnoses associated with testicular cancer?

A

Epididymal cyst
Missed testicular torsion
Infection (epididymo-orchitis)

65
Q

What initial investigations may be carried out to test for testicular cancer?

A

MSSU
Testicular USS & CXR
Tumour markers (blood test)

66
Q

What is the treatment for testicular cancer?

A

Radical orchidectomy

67
Q

Do you ever biopsy in testicular cancer?

A

No (maybe contralateral side for high risk tumours)

68
Q

In testicular cancer, where is the main lymphatic spread observed?

A

Para-aortic lymph nodes

69
Q

Where is the incision made when performing radical orchidectomy?

A

Groin (inguinal) region

70
Q

What is the most common pathology of testicular cancers?

A

Germ cell tumour (95%)
Seminomatous GCT
Non-seminomatous GCT

71
Q

What types of Non-GCT of testicular cancer can be found?

A

Leydig
Sertoli
Lymphoma

72
Q

Which pathological type of GCT testicular cancer affects those 30-40yrs?

A

Seminoma

73
Q

Which pathological type of GCT testicular cancer affects those 20-30yrs

A

Non-seminomatous

74
Q

If a tumour is low grade, what will the cells be like?

A

Well-differntiated

75
Q

Why is tumour grading useful?

A

Tells you about the aggressiveness of a tumour

76
Q

If a tumour is high grade, what will the cells be like?

A

Poorly differentiated

77
Q

What does tumour staging refer to?

A

The spread of the tumour

78
Q

What are the different types of tumour spread which can occur?

A 
Local spread
Regional spread (lymph)
Distant spread (metastatic)
79
Q

How many different stages are present in testicular cancer?

A

4

80
Q

What can be administered in combination with orchidectomy?

A

Adjuvant radiotherapy

or in metastatic disease = chemotherapy

Urinary (17 decks)

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