Disease of the Prostate Flashcards
What are the different McNeal zones of the prostate?
Transitional zone
Peripheral zone
Central zone
Anterior fibromuscular stroma
Which zone of the prostate is most likely to cause obstruction of urethra?
Transition zone
Which zone of the prostate is likely to undergo hypertrophy?
Transition zone
Which zone is likely to be felt whilst performing PR examination?
Peripheral zone
What does BPE stand for?
Benign Prostatic enlargement
What does BPH stand for?
Benign prostatic hyperplasia (pathological finding)
What does BPO stand for?
Benign prostatic obstruction (clinical entity)
What does BOO stand for?
Bladder outflow obstruction
What does LUTS stand for?
Lower urinary tract symptoms
What does the Hald diagram demonstrate?
BOO
BPE
LUTS
These 3 can coexist or occur independently
Where does hyperplasia of the prostate usually occur?
Transition zone
Will BPH result in BOO?
Not always
Why is BPE so common in men over 60 yrs?
The prostate gland continues to grow throughout life
What are some obstructive LUTS?
Hesitancy
Poor stream
Terminal driblling
Incomplete emptying
What are some storage or irritative LUTS?
Frequency
Nocturia
Urgency +/- urge incontinence
What are some of the physical findings on examination of someone with BPE?
Palpable bladder
PR examination - enlarged prostate
What is phimosis?
Inability to pull foreskin back, becomes tight
What is para-phimosis?
When the foreskin is retracted but does not move back (emergency)
When feeling for a prostate what are you assessing?
Size
Texture
Consistency
Tenderness
What investigations might you do if suspected BPE?
MSSU Flow rate study Post-void bladder residual USS Bloods : PSA & urea, creatinine Flexible cystoscopy
What are the 2 types of BPO?
Uncomplicated
Complicated
What are the treatment options for uncomplicated BPO?
Watchful waiting
Alpha blockers
5 alpha reductase inhibitors (combo)
TURP
Prostectomy
What is the main medical treatment for BPO?
Alpha blockers
How do alpha blockers mediate action?
Cause smooth muscle relaxation of internal urethral sphincter & prostate
What alpha blocker is highly selective?
Tamsulosin
What might be one of the side effects of an alpha blocker? Why?
Retrograde ejaculation (relaxation of internal urethra sphincter)
What is the action of 5 reductase inhibitors?
Prevents the conversion of testosterone to dihydrotestosterone
What effect does 5 redcoats inhibitors have on prostate?
Reduces testosterone therefore size of prostate
What does TURP stand for?
Transurethral resection of prostate
What is the gold standard surgical treatment for BPO?
TURP
What are some of the side effects of TURP?
Bleeding
Infection
Retrograde ejaculation
What are some of the complications of BOO?
Acute/ chronic urinary retention Urinary incontinence (overflow) UTI Bladder stones Renal failure
What are some options for complicated cases of BOO?
Catheterisation
Intermittent self-catheterisaition
What is the commonest cause of cancer in men?
Prostate cancer
What blood test would you perform to test for prostate hypertrophy?
PSA
What are the main risk factors of prostate cancer?
Age
Race (AAs increased risk)
Family history
Which zone of the prostate is usually affected with cancer?
Peripheral zone
Which zone does the urethra extend through?
Transition zone
What symptoms usually present with prostate cancer?
Asymptomatic
80% of prostate cancers are said to be ____ therefore have a better prognosis.
Localised
How are the majority of prostate cancers diagnosed?
Through opportunistic PSA testing
What is the diagnostic triad of prostate cancer?
PSA
Digital rectal examination
TRUS-guided prostate biopsy
If a prostate cancer is locally invasive, what are some of the symptoms which might be experienced?
Haematuria Incontinence Impotence Haemospermia Loin pain or auria
Where is the most common area of metastatic spread in prostate cancer?
Bone
Screening for prostate cancer was proved non beneficial because it lead to ______.
Over-treatment
Over-diagnosis
Which areas of the population do you target with ad-hoc PSA testing?
Older males (urinary problems?)
What is PSA?
Kallikrein serine protease produced by glands of prostate but can leak into serum
What is the normal range for PSA?
0-0.4ug/ml
Why do levels of PSA increase with age?
Prostate gland continues to grow throughout life
Other than prostate cancer, what else can cause increased PSA?
UTI PR examination Catheterisation Ejaculation BPH
If the level of PSA >10, what is the likelihood of cancer?
70%
What are the different grades of prostate cancer?
Score 3-5
What is the Gleason SUM score composed of?
Most common histological cell type + the second most common cell type
What is the highest/ lowest Gleason score?
6
10
What investigations may be useful to identify prostate staging?
Digital rectal examination PSA CT scan MRI Transrectal US guided biopsy
What are some of the main treatments used for localised prostate cancer?
Watchful waiting
Radiotherapy (external beam or brachytherapy)
Radical prostatectomy
What are some types of hormonal therapy used for metastatic prostate cancer?
Bilateral orchidectomy
Chemical castration (LHRH Antagonist)
Oestrogen
What are the different stages of prostate cancer/
Localised Locally advanced (T3-4, N0) Metastatic (T, N1 or M1)
What is the usual presenting sign of testicular cancer?
Painless lump
What are the lesser common presenting signs of testicular cancer?
Inflammed, tender swelling
History of trauma
In what population is testicular cancer most common?
Young men (3rd decade)
What are the main risk factors for testicular cancer?
Testicular maldescent
Infertility
Atrophic testis
Previous cancer
What are the tumour markers associated with testicular cancer which can be tested for in the blood?
AFP (alpha-fetoprotein)
bHCG (Human chorionic gonadotrophin)
LDH (lactate dehydrogenase)
What are the differential diagnoses associated with testicular cancer?
Epididymal cyst
Missed testicular torsion
Infection (epididymo-orchitis)
What initial investigations may be carried out to test for testicular cancer?
MSSU
Testicular USS & CXR
Tumour markers (blood test)
What is the treatment for testicular cancer?
Radical orchidectomy
Do you ever biopsy in testicular cancer?
No (maybe contralateral side for high risk tumours)
In testicular cancer, where is the main lymphatic spread observed?
Para-aortic lymph nodes
Where is the incision made when performing radical orchidectomy?
Groin (inguinal) region
What is the most common pathology of testicular cancers?
Germ cell tumour (95%)
Seminomatous GCT
Non-seminomatous GCT
What types of Non-GCT of testicular cancer can be found?
Leydig
Sertoli
Lymphoma
Which pathological type of GCT testicular cancer affects those 30-40yrs?
Seminoma
Which pathological type of GCT testicular cancer affects those 20-30yrs
Non-seminomatous
If a tumour is low grade, what will the cells be like?
Well-differntiated
Why is tumour grading useful?
Tells you about the aggressiveness of a tumour
If a tumour is high grade, what will the cells be like?
Poorly differentiated
What does tumour staging refer to?
The spread of the tumour
What are the different types of tumour spread which can occur?
Local spread Regional spread (lymph) Distant spread (metastatic)
How many different stages are present in testicular cancer?
4
What can be administered in combination with orchidectomy?
Adjuvant radiotherapy
or in metastatic disease = chemotherapy
