Mindmaps Prostatic Hyperplasia and Prostate cancer Flashcards
What is Benign Prostatic Hyperplasia
Benign enlargement of the prostate gland, particularly in the transitional zone
Common with increasing age
Cause and pathophsyiology of BPH
Hypertrophy of the epithelial and stromal cells of the prostate gland
Classically occurs in the transitional zone of the prostate gland and is thought to be driven by the androgen dihydrotestosterone
What zone of the prostate is most often site of BPH
Transitional zone
Signs and symptoms of BPH or non-metastasised prostate cancer
FUN BOO: Frequency Urgency Nocturia those of Bladder Outflow Obstruction: Hesitancy Intermittent flow/poor urine stream/dribbling Incomplete bladder emptying
Complications of BPH
Urinary retention
Recurrent UTIs
Impaired renal function
Haematuria
Investigations of BPH
Per rectum examination
Urine dipstick, microscopy and culture
Bloods
Prostate specific antigen (PSA) - usually raised
Radiology - ultrasound scan of the urinary tract, transrectal ultrasound scan
What would found in a per rectum examination of someone with BPH
An enlarged but smooth prostate gland with a palpable midline sulcus
Blood investigations of BPH
FBCs
U and Es
Creatinine (renal function)
LFTs
Conservative management of BPH
Conservative: Watchful waiting is usually adopted in mild disease
Then generally:
*Completion of the International Prostate Symptom Score (IPSS). Completion of a voiding diary to see if patient is bothered by their symptoms.
Medical treatment of BPH
Alpha 1-adrenoreceptor blockers e.g. tamsulosin
5 alpha-reductase inhibitor e.g. finasteride
Surgical treatment of BPH
Transurethral resection of the prostate (TURP)
Most common site of prostate cancers
Peripheral zone of prostate gland
70-80% of prostate cancers
Sites of prostate cancers
Peripheral zone (70-80%) Transitional zone (10-20% all prostate cancers and most common site for BPH) Central zone (2.5%)
Characteristics of prostate cancer of central zone
Aggressive
Spread to seminal vesicles
What is prostate cancer
Usually an adenocarcinoma that arises from the peripheral zone of the prostate gland
Risk factors of prostate cancer
Increasing age
Family Hx or prostate cancer
More common in African populations
Signs and symptoms of metastatic prostate cancer
Weight loss
Malaise and fatigue
Usually spreads to the bone, therefore bone pain (pathological fracture)
Complications of prostate cancer
Metastasis
Death
Urinary incontinence
Erectile dysfunction
Investigations of prostate cancer
Per rectum examination
Urine dipstick, microscopy and culture
Bloods
Prostate Specific Antigen (PSA) - usually raised
Radiology - transurethral ultrasound and biopsy
What would you see on per rectum examination of prostate cancer (and how is it different to BPH)
An enlarged prostate gland that may be uni-nodular or multi-nodular.
Midline sulcus is usually no longer palpable (unlike BPH where is usually is).
What would happen if transrectal ultrasound and biopsy where to detect a malignany?
Patient should be sent for a MRI and bone scan to look for distant metastases
How is prostate cancer staged
TMN system
Conservative management of prostate cancer
Involvement of Macmillan nurses and psychological support
Medical management of prostate cancer
Radiotherapy
Brachytherapy
Goserelin (Zoladex) - a luteinising hormone-releasing hormone (LHRH) agonist
Anti-androgens e.g. cyproterone
Surgical management of prostate cancer
Laproscopic radical prostatectomy
Transurethral resection of the prostate (TURP)
2 pharmacological therapies of BPH (type and example)
5-alpha reductase inhibitors - Finasteride
Alpha blockers - tamsulosin
Give 2 difference on digital rectal examination of BPH and Prostate carcinoma
BPH = smooth + regular shaped Carcinoma = hard + irregular shaped
Tests of BPH
Prostate Specific Antigen Test
Ultrasound scan of urinary tract and prostate
Trans-rectal ultrasound guided biopsy
