Men's Health

Question 1

What is BPH

Answer 1

Hyperplasia of the stromal and epithelial cells of the prostate. Affects men in older age (usually over 50 years).

Question 2

Sx of BPH

Answer 2

Voiding LUTS Sx:
Straining
Hesitancy
Intermittency
Poor stream
Dribbling

Question 3

Ix for BPH

Answer 3

DRE = smooth, enlarged prostate
Prostate specific antigen PSA = to rule out prostate cancer but not very accurate

Question 4

What are common causes of a raised PSA?

Answer 4

Prostate cancer
Benign prostatic hyperplasia
Prostatitis
Urinary tract infections
Vigorous exercise (notably cycling)
Recent ejaculation or prostate stimulation

Question 5

Tx of BPH

Answer 5

1st line: Alpha-blockers (e.g. tamsulosin) relax bladder neck
2nd line: 5-alpha reductase inhibitors (e.g. finasteride) reduce the size of the prostate = decrease testosterone production = converts to dihydrotestosterone (DHT), which is a more potent androgen hormone.

Surgical: TURP (Transurethral resection of the prostate)

Question 6

Side effects of both tamsulosin and finasteride

Answer 6

Tamsulosin: postural hypotension
Finasteride: sexual dysfunction due to decreased testosterone

Question 7

Which androgen hormone does prostate cancer rely on to grow?

Answer 7

Testosterone

Question 8

What kind of cancer is prostate cancer most commonly classified as?

Answer 8

Adenocarcinoma

Question 9

RF for prostate cancer? (3)

Answer 9

Increasing age
Family history
Black African or Caribbean origin
Tall stature
Anabolic steroids - the ones gym bros use

Question 10

Sx of prostate cancer

Answer 10

LUTS
Haematuria
Erectile dysfunction
Cancer sx

Question 11

Ix for prostate cancer

Answer 11

PR exam - hard, irregular, asymmetrical, craggy
PSA (prostate specific antigen) - it’s unreliable with high rates of false positives and negatives
Multiparametric MRI + prostate biopsy

Question 12

What can cause a raise in PSA other than prostate cancer?

Answer 12

Benign prostatic hyperplasia
Prostatitis
Urinary tract infections
Vigorous exercise (notably cycling)
Recent ejaculation or prostate stimulation

Question 13

Tx of prostate cancer

Answer 13

If local:
< 70 yrs - prostatectomy
> 70 yrs + low risk - wait & watch

If metastatic:
Chemo/radio
+
Hormone therapy i.e. androgen receptor blockers or GnRH agonists

Rare: bilateral orchiectomy - testicle removal

Question 14

SE of hormone therapy in prostate cancer (3)

Answer 14

Hot flushes
Sexual dysfunction
Gynaecomastia
Fatigue
Osteoporosis