Prostate

Question 1

3 zones of prostate and their roles

Answer 1

Central zone: surrounds ejaculatory ducts
Transitional zone: surrounds urethra. Typical zone of BPE change
Peripheral zone: post easily palpated on DRE. Typical zone of inflammation/Ca prostate
Fibromuscular zone/stroma

Question 2

Tests to do in suspected BPE

Answer 2

abdo exam, DRE, history, bloods, urine dip, flow rate, flexible cystoscopy, USS

Question 3

Conservative management for BPH

Answer 3

Lifestyle modification: no caffeine and drinking at night. Double void

Question 4

Medical management of BPH

Answer 4

Alpha blockers: relax smooth mm in prostate
SE: hypotension, ED, retrograde ejaculation, headache, nasal congestion

5AR inhibitors: inhibit DHT production:
SE: decreased libido, ED, teratogenicity

long term cathetirsation

Question 5

Surgical management of BPH

Answer 5

Trans urethral resection of prostate
URoloft, aqua-ablation

Question 6

Prostate cancer presentation

Answer 6

LUTS
haematuria
signs of advanced disease: bony pain, cancer cachexia, lymphoedema, cord compression

Question 7

Diagnosis of prostate cancer

Answer 7

PSA
DRE
mpMRI
Biopsy
Bone scan

Question 8

How is graiding of prostate cancer done

Answer 8

Gleason score: biopsy gives idea of if the cells look normal. Higher score = high risk
PIRADS/Likert score: >4 clinically significant. This is done. by MRI

Question 9

Function of GnRH agonists in prostate cancer treatment

Answer 9

Prevent pituitary from secreting LH
Risk of androgen flare which will make symptoms worse initially therefore given anti-androgen therapy initially

Question 10

Function of GnRH antagonists in prostate cancer treatment

Answer 10

Prevent LNRH from binding to its receptors in the pituitary gland
Do not cause androgen flare

Question 11

Which prostate cancer treatment causes androgen flare

Answer 11

LNRH agonists / GnRH agonists

Question 12

Function of anti-androgen therapy

Answer 12

Stops testosterone reaching cancer cells

Question 13

What Is prostatitis

Answer 13

Presence of inflammatory cells in glandular epithelium and lumens of the prostate

It is an ascending urethral infection

Question 14

commonest bacteria causing prostatitis

Answer 14

E coli, enterobacter, proteus, Neisseria gonorrhea, chlamydia

Question 15

Prostatitis presentation

Answer 15

Dysuria, frequency, urgency, nocturne, pyrexia
Urethral discharge
Lower abdo. lower back pain

Question 16

Diagnosis of prostatitis

Answer 16

Largely clinical
History exam, DRE,
Bloods

Question 17

Treatment of prostatitis

Answer 17

For bacterial: supportive, abx for 4-6 weeks

Question 18

For chronic pelvic pain syndrome what is treatment

Answer 18

Physio, alpha blockers, neuropathic analgesi