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Urology (Surgery) > Prostate > Flashcards

Prostate Flashcards

1
Q

where does prostate cancer rank in the most common cancers in men

A

first

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2
Q

what is the behind the development of prostate cancer

A

androgens (testosterone and dihydrotestosterone)

in the prostate testosterone is converted into dihydrotestosterone which is more potent

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3
Q

what is the most common type of prostate cancer

A

adenocarcinoma

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4
Q

where in the prostate are most cancers found

A

posterior peripheral zone

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5
Q

what are the 2 types of prostate adenocarcinomas and which carries a higher risk of mets

A

acinar and ductal

ductal carries a higher risk of mets and it grows quicker than acinar adenocarcinomas

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6
Q

risk factors for prostate cancer

A

increasing age

black African and Caribbean ethnicity

family history

obesity, diabetes, smoking, exercise (protective)

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7
Q

clinical features of localised and metastatic prostate cancer

A

localised = LUTS; weak stream, hesitancy, terminal dribble, urgency, frequency, nocturia

metastatic = bone pain, lethargy, unexplained weight loss

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8
Q

what conditions can raise PSA

A

prostate cancer

BPH

Prostatitis

vigorous exercise

Catheter

Urinary retention

recent DRE

large prostate

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9
Q

investigations into suspected prostate cancer

A

DRE

PSA - however is raised in other conditions

transperineal or transrectal biopsy

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10
Q

what imaging technique is used to view prostate cancers

A

Mp-MRI (identifies abnormal areas of the prostate)

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11
Q

management of low risk prostate cancer

A

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

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12
Q

what is the main surgical management of prostate cancer and what is the main complication

A

radical prostatectomy

ED - affects up to 60-90% of men

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13
Q

mainstay of treatment in localised prostate cancer

A

radiotherapy

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14
Q

what types of treatments are used in metastatic prostate cancer

A

chemotherapy

anti-hormonal agents

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15
Q

examples of anti-hormonal agents used in metastatic prostate cancer and how they work

A

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

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16
Q

what is the most common cause of LUTS in men

A

BPH

17
Q

what enzyme is responsible for converting testosterone into its more potent form dihydrotestosterone

A

5a-reductase

18
Q

risk factors of BPH

A

black African and Caribbean ethnicity

family history

increasing age

obesity

19
Q

clinical features of BPH

A

LUTS; hesitancy, terminal dribble, weak stream, incomplete emptying

haematuria is rare but can be a symptom

20
Q

investigations into BPH

A

DRE

urinalysis

post-void bladder scan

PSA

21
Q

how does a BPH prostate feel compared to a cancerous prostate

A

BPH = smooth, firm, symmetrical

Cancer = hard, irregular, asymmetrical

22
Q

conservative management of BPH

A

reduce caffeine and alcohol intake

keep symptom diary

23
Q

what drugs can be given in BPH - what class are they and how do they work

A

Alpha blocker - Tamsulosin - relaxes prostatic smooth muscle

5a-reductase inhibitor - Finasteride - prevents conversion of testosterone into dihydrotestosterone

24
Q

when would you use finasteride vs tamsulosin

A

tasmsulosin for symptomatic relief - works after a few days

finasteride takes up to 6 months to work

25
Q

surgical management of BPH

A

Trans Urethral Resection of the Prostate (TURP)

26
Q

what is the main complication of BPH

A

high pressure retention - results in AKI

27
Q

what is prostatitis

A

inflammation of the prostate gland

28
Q

what is the most common urological problem in men under 50yrs

A

prostatitis

29
Q

what is the pathophysiology behind prostatitis and what is the main causative organism

A

ascending urethral infection

most common organism is E.coli

30
Q

risk factors for prostatitis

A

indwelling catheter

immunosuppressed

recent surgery including cystoscopy

phimosis or urethral stricture

31
Q

clinical features of prostatitis

A

LUTS

fever or lethargy

suprapubic or peroneal pain

urethral discharge

(on examination usually shows a very tender prostate)

32
Q

investigations into suspected prostatitis

A

urine culture (guide antibiotic therapy from the results)

STI screen and routine bloods

33
Q

management of prostatitis

A

prolonged antibiotic treatment

and suitable analgesia

(alpha blockers and 5a-reductase inhibitors can be used as second line therapy)

34
Q

what type of antibiotic is used in patients with prostatitis and why

A

typically a quinolone as it has good penetration into the prostate

Urology (Surgery) (5 decks)

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