Prostate Flashcards
where does prostate cancer rank in the most common cancers in men
first
what is the behind the development of prostate cancer
androgens (testosterone and dihydrotestosterone)
in the prostate testosterone is converted into dihydrotestosterone which is more potent
what is the most common type of prostate cancer
adenocarcinoma
where in the prostate are most cancers found
posterior peripheral zone
what are the 2 types of prostate adenocarcinomas and which carries a higher risk of mets
acinar and ductal
ductal carries a higher risk of mets and it grows quicker than acinar adenocarcinomas
risk factors for prostate cancer
increasing age
black African and Caribbean ethnicity
family history
obesity, diabetes, smoking, exercise (protective)
clinical features of localised and metastatic prostate cancer
localised = LUTS; weak stream, hesitancy, terminal dribble, urgency, frequency, nocturia
metastatic = bone pain, lethargy, unexplained weight loss
what conditions can raise PSA
prostate cancer
BPH
Prostatitis
vigorous exercise
Catheter
Urinary retention
recent DRE
large prostate
investigations into suspected prostate cancer
DRE
PSA - however is raised in other conditions
transperineal or transrectal biopsy
what imaging technique is used to view prostate cancers
Mp-MRI (identifies abnormal areas of the prostate)
management of low risk prostate cancer
surveillance - 3/12 PSA and 6/12 DRE
grows slowly so have to ask yourself whether there is any point putting a man on tablets or through radiotherapy that will make him feel worse than if you just left it
what is the main surgical management of prostate cancer and what is the main complication
radical prostatectomy
ED - affects up to 60-90% of men
mainstay of treatment in localised prostate cancer
radiotherapy
what types of treatments are used in metastatic prostate cancer
chemotherapy
anti-hormonal agents
examples of anti-hormonal agents used in metastatic prostate cancer and how they work
GnRH agonists - inhibits the pituitary gland from producing LH
does this through permanent secretion of GnRH, which if it was pulsatile would increase production of LH - however when it is switched on all the time, LH is not released - resulting in much reduced levels of testosterone to castration levels
what is the most common cause of LUTS in men
BPH
what enzyme is responsible for converting testosterone into its more potent form dihydrotestosterone
5a-reductase
risk factors of BPH
black African and Caribbean ethnicity
family history
increasing age
obesity
clinical features of BPH
LUTS; hesitancy, terminal dribble, weak stream, incomplete emptying
haematuria is rare but can be a symptom
investigations into BPH
DRE
urinalysis
post-void bladder scan
PSA
how does a BPH prostate feel compared to a cancerous prostate
BPH = smooth, firm, symmetrical
Cancer = hard, irregular, asymmetrical
conservative management of BPH
reduce caffeine and alcohol intake
keep symptom diary
what drugs can be given in BPH - what class are they and how do they work
Alpha blocker - Tamsulosin - relaxes prostatic smooth muscle
5a-reductase inhibitor - Finasteride - prevents conversion of testosterone into dihydrotestosterone
when would you use finasteride vs tamsulosin
tasmsulosin for symptomatic relief - works after a few days
finasteride takes up to 6 months to work
