GU

Question 1

Which anatomical zone of the prostate does prostate cancer commonly affect?

Answer 1

The peripheral zone.

Question 2

Where can prostate cancer commonly metastasise to?

Answer 2

Lymph nodes and bone.

Question 3

What investigations might you do in someone who you suspect has prostate cancer?

Answer 3

• Serum: PSA.
• Urine: PCA3 and gene fusion products.
• DRE - hard, irregular, craggy.
• History of LUTS.
• Trans-rectal USS.
• Prostate biopsy.

Question 4

Other than prostate cancer. What can cause an elevated PSA?

Answer 4

1. Benign prostate enlargement.
2. UTI.
3. Prostatitis.

Question 5

What grading system is used in prostate cancer?

Answer 5

Gleason grading.

The higher the score the more aggressive the cancer.

Question 6

What is the treatment for localised prostate cancer?

Answer 6

• Observation.
• Surgery - radical prostatectomy.
• Radiotherapy (external beam).
• Adjuvant hormones.

Question 7

What is the treatment for metastatic prostate cancer?

Answer 7

Palliative treatment e.g. hormone therapy - androgen deprivation.

Question 8

Give 2 advantages and 2 disadvantages of screening in prostate cancer.

Answer 8

• Screening can lead to early diagnosis/early treatment and so cure or effective palliation.
• Uncertain natural history.
• Screening leads to over diagnosis and treatment.

Question 9

Give 5 causes of haematuria.

Answer 9

1. Kidney tumour, trauma, stones, cysts.
2. Ureteric stones or tumour.
3. Bladder infection, stones or tumour.
4. BPH or prostate cancer.

Question 10

What is PSA?

Answer 10

A glycoprotein secreted by the prostate into the blood stream.

Question 11

Give 4 symptoms of BPH.

Answer 11

1. Increased frequency of micturition.
2. Nocturia.
3. Hesitancy.
4. Post-void dribbling.

Question 12

Describe the treatment for BPH.

Answer 12

1. Mild symptoms: watchful waiting.
2. Alpha-1-antagonists e.g. tamulosin.
3. 5-alpha-reductase inhibitors.
4. TURP if not responsive

Question 13

Give an example of a 5- alpha -reductase inhibitor and how it is effective

Answer 13

FINASTERIDE

- block synthesis of dihydrotestosterone from testosterone and can reduce symptoms

Question 14

How does tamulosin work in improving the symptoms of BPH?

Answer 14

Tamulosin is an alpha-1-antagonist. It works by relaxing the smooth muscle in the bladder neck and prostate and so increases urinary flow. This improves obstructive symptoms.