Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BPH > Prognosis > Flashcards

Prognosis Flashcards

1
Q

Olmsted country

prevalence of moderate to severe LUTS in over 50

A

30%
46% in over 70
26% in 40-49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q 
Olmsted country
author
year
number of men
age groups
assessment 
follow up period
A 
Jacobsen
1999
2115 white men randomly selected
no previous drug therapy
40-79
3 contacts in 42 months, IPSS and flow rate
25% had trus for prostate size
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

increase in LUTS symptoms in Olmsted

A

0.18 AUA SI points per year on average

rate of increase higher in men in 70s vs 40s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

incidence of AUR over 4 years in Olmsted county

A

2.7% cumulative incidence over 4 years
57 men out of 2115

AUR risk 40-49 3/1000
9/1000 in 70-79 if IPSS less than 7
34/1000 if IPSS >7
risk AUR 1% for men in 50s, 9% in over 70

3% had TURP, although 9.5% in men 70-79

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

risk factors for progression - 7

A 
PSA over 1.4 4x
volume over 30 4x
Age 70-79 8x
qmax <12 4x
AUA SS >8 3x
PVR more than 50mls 3x
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q 
PLESS study
author
year
drugs
follow up period
A 
McConnell
1998, NEJM
proscar long term efficacy and safety study
finasteride vs placebo
4 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
PLESS finasteride effect
prostate size
symptom score
flow
risk of surgery retention
A

Proscar long term efficacy and safety study
3040 men with mod severe luts, qmax less than 15, PSA less than 10
designed to enrol men with large prostate so mean volume 54 mls

18% reduction volume, volume increased 14% in placebo
symptoms score down 1.6
flow improved 2 ml/sec
reduction retention and surgery 55% from 10 to 5%
AUR risk reduced 7 to 3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PLESS risk factor for retention
PSA
prostate volume

A

8 x if PSA more than 1.4

3 x if volume more than 40cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PLESS side effect finasteride

A 
decreased libido
impotence
reduced volume ejaculate
breast enlargement
rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

prostate volume change in PLESS

A

decreased 18% in FIN group

increased 14% in placebo group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

alpha blocker MA
IPSS score improvement
qmax improvement
side effect profile

A 
Djavan MA
Eur Urol 1999
IPSS improvement 30-40%
flow rate improvement 16-25%
alfuzosin and tamsulosin better SE profile
tamsulosin lower effect on BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ALFAUR study
RR of twoc
RR of need surgery 6 months

A

2005
McNeil
RRR 27% at 72 hours of alfuzosin for retention
29% decreased need surgery at 6 months when continued treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q 
MTOPS
author
year
men
arms
follow up
A 
medical therapy of prostatic symptoms
mcConnell
2003
NEJM
2047 men
FIN, DOX
4.5 years follow up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q 
MTOPS selection criteria
mean PSA
median prostate volume
age
IPSS
markers of progression 6
A 
volume 31 cc
PSA median 1.6
PSA 10 or less
age 50 or more
IPSS 8-30 limited at 30
markers of progression
AUR
failed twoc
IPSS >4
creatinine >133
recurrent UTI
incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

AUR rate in MTOPS

A

placebo 0.6% AUR rate
FIN or FIN+DOX reduce risk surgery and retention
DOX alone did not reduce risk AUR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

symptom score improvement MTOPS

A

FIN and DOX diverge difference at year 4

IPSS improvement DOX 6 points, FIN 4 points, FIN and DOX 7 points, placebo 5 points

17
Q

QMax improvement MTOPS

A

DOX 4 ml/sec
FIN 2ml/sec
FIN and DOX 5 ml.sec

18
Q

evidence for psa reduction

A

from MTOPS

FIN reduced PSA by 50%

19
Q

MTOPS reduction progression

reduction in retention with DOX

A

39%
35%

versus FIN alone
34%
68%
versus COMBO
66%
81%
20
Q 
CombAT
author
year
patients
arms
follow up
A 
Roehrborn
2007
4844 patients
DUT and TAM
four years
21
Q 
CombAT
median prostate volume
age
IPSS
PSA selection
primary end points
A 
median prostate volume 49cc so bigger than MTOPS
PSA 1.5 to 10
age 50 or more
IPSS 12 or more
time to surgery or AUR
22
Q

CombAT results

DUT vs TAM time line to drop in IPSS

A

combo better than both for symptoms
combo better than TAM alone for reduction surgery and retention

TAM rapid reduction in IPSS from baseline by 5 in 3 months
DUT took 15 months to reach same drop
DUT and TAM same rapid reduction by 4 months but better than TAM alone by 9 months which was sustained over 2 years
reduction in AUR and BPH surgery with DUT or DUT and TAM vs TAM alone
but no difference in reduction retention and surgery in combo vs dut alone
RRR 65% at year 4
ARR 11.9% vs 4.2% diversing from TAM alone by 8 month

23
Q

haematuria and FIN paper

A

Kearney J Urol 2002
Finasteride for haematuria
75% had no further haematuria at 3 years

24
Q

what change in IPSS related to subjective worsening of LUTS

A

4 points

25
Q

aur risk in olmsted country in 50s and 70s

A

1% in 50s vs 9% in over 70

26
Q

olmsted county median peak flow

A

21 in 40-49

14 in 70-79

27
Q 
national prostatectomy audit
year
no of men
how many having elective operation
great improvement
how many worse
death rate
A 
1992
5337 men
1/3 having elective operations
64% better
4% worse
death rate 0.2%
28
Q 
UPSTREAM
author
year
type
primary outcome
secondary outcome
no men
A 
Drake
2020
non inferiority RCT
18 months change in IPSS
surgery as secondary outcome
860 men randomised to RC and UDS
UDS arm showed non inferiority of mean IPSS
29
Q

abrams paper expected improvement luts in boo vs no boo

A

90% vs 60% after turp if BOO vs no BOO

30
Q

reynard paper 1998 ICS BPH study

A

> 1200 men
ipss, uroflow and PFS
Qmax of 10mls/sec had PPV of 70% for BOO based on PFS done, sensitivity 47%
15 mls/sec specificity 38% and PPV 67%, sensitivity 82%
Thus 53% of BOO had flow rate of over 10ml/sec
18% of patients with BOO had flow rate of over 15ml/sec

30
Q

reynard paper 1998 ICS BPH study

A

> 1200 men
ipss, uroflow and PFS
Qmax of 10mls/sec had PPV of 70% for BOO based on PFS done, sensitivity 47%
15 mls/sec specificity 38% and PPV 67%, sensitivity 82%
Thus 53% of BOO had flow rate of over 10ml/sec
18% of patients with BOO had flow rate of over 15ml/sec

31
Q

risk factors AUR

A 
volume more than 30
PSA more than 1.4
IPSS more than 7
Qmax less than 12
age more than 70 vs 40-49
PVR

BPH (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions