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UROLOGY > PROSTATE > Flashcards

PROSTATE Flashcards

1
Q

McNEEL’S ZONES of PROSTATE

A
  1. Central Zone
  2. Transitional Zone
  3. Peripheral Zone
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2
Q

LOBES OF PROSTATE

A
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3
Q

BPH MOST COMMONLY INVOLVES which ZONE of PROSTATE

A

Transitional Zone

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4
Q

Primary PROSTATE CANCER usually affects which zone

🧠⚡3Ps⚡

A

Primary PROSTATE CANCER
⬇️
Posterior LOBE
⬇️
PERIPHERAL Zone affected

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5
Q

⭐ Central & TRANSITIONAL Zone contains which type of Glands

⭐ PERIPHERAL Zone contains which type of Glands

A

⭐ Central & TRANSITIONAL Zone contains which type of Glands
🎯 SHORT UNBRANCHED GLANDS

⭐ PERIPHERAL Zone contains which type of Glands
🎯 LONG BRANCHED GLANDS

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6
Q

Which ZONES are removed in TURP

A

Central
➕
Transitional
➕
Most of the PERIPHERAL zone

⭐ A Portion of PERIPHERAL ZONE is left behind

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7
Q

Why BPH patient CAN STILL DEVELOP PROSTATE CANCER even after TURP

A

⭐ A Portion of PERIPHERAL ZONE is left behind

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8
Q

FALSE CAPSULE in BPH is formed by

A

Transitional zone

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9
Q

Between TRUE PROSTATE CAPSULE & FALSE PROSTATE CAPSULE, lies

A

PROSTATIC VENOUS PLEXUS

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10
Q

Relation NERVE Bundles responsible for ERECTION with Prostate Capsule

A

Posterolateral to CAPSULE

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11
Q

NERVE Bundles responsible for ERECTION can be injured in which PROCEDURE

A

Radical PROSTATECTOMY

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12
Q

⚡⚡ MOST COMMON COMPLICATION following TURP

A

Retrograde EJACULATION

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13
Q

Cause of Retrograde EJACULATION after TURP

A

Bladder neck & sphincter damage during TURP

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14
Q

Retrograde EJACULATION
Classical FEATURE

A

No SEMEN during INTERCOURSE
➕
SEMEN comes OUT LATER in URINE

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15
Q

Types of PROSTATIC STONES

A
  1. Endogenous
    ✨ Less COMMON
  2. Exogenous
    ✨ MORE COMMON
    ✨ From KIDNEY or BLADDER
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16
Q

⚡⚡ MOST COMMON ENDOGENOUS Stone OF PROSTATE

A

Calcium PHOSPHATE

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17
Q

💊💉 MANAGEMENT of PROSTATIC STONE

A

No management required

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18
Q

Corpora AMYLACEA

A

Lamellated bodies found in PROSTATE

✨ Precursor for PROSTATIC STONES

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19
Q

⚡⚡ MOST COMMON CAUSE of ACUTE BACTERIAL PROSTATITIS

A

E. coli

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20
Q

Tender BOGGY PROSTATE is a Characteristic feature of

A

Acute PROSTATITIS

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21
Q

Prostatic massage should be avoided in ACUTE PROSTATITIS
WHY?

A

Can lead to SEPTICEMIA

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22
Q

Threads in URINE EXAMINATION seen in

A

Acute PROSTATITS
Chronic PROSTATITIS

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23
Q

Long ANTIBIOTIC THERAPY is needed for ACUTE PROSTATITIS
Why?

A

Antibiotics don’t penetrate PROSTATIC CAPSULE
⬇️
Continue for longer duration
2-3 WEEK Therapy

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24
Q

Causes of CHRONIC Prostatitis

A

Repeated episodes of ACUTE PROSTATITIS

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25
Q

🧑🏻‍⚕️ Clinical Features of CHRONIC PROSTATITIS

A
  1. Prostatodynia (Dull Perineal or Pelvic Pain)
  2. Dysuria
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26
Q

3 TUBE TEST
✨ synonyms
✨ USED for?

A

✨ synonyms
STANDARD MEARES & STAMEY TEST

✨ USED for?
🎯 CHRONIC PROSTATITIS

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27
Q

3 TUBE TEST
Procedure

A

✨ 1st TEST TUBE contains: 1st VOIDED URINE: 10ml (Probably comes from URETHRA)

✨ 2nd TEST TUBE contains: MIDSTREAM SAMPLE (Probably comes from BLADDER)
⬇️
⬇️ do PROSTATIC MASSAGE

✨ 3rd TEST TUBE contains: 1st Voided Sample POST PROSTATIC MASSAGE
⬇️
If CHRONIC PROSTATITIS ➕ ➡️ THREADS ➕

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28
Q

DURATION OF ANTIBIOTIC THERAPY IN CHRONIC PROSTATITIS
🧠⚡Double that of ACUTE⚡

A

4-6 weeks
✨ Ciprofloxacin
✨ Trimethoprim
✨ Doxycycline

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29
Q

STORAGE (IRRITATIVE) SYMPTOMS (LUTS)

🧠⚡FUN IN Pain⚡

A
  1. Frequency
  2. Urgency
  3. Nocturia
  4. Incontinence
  5. Pain
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30
Q

VOIDING ( OBSTRUCTIVE) SYMPTOMS (LUTS)
🧠⚡WISE Person⚡

A
  1. Weak stream
  2. Intermittency
  3. Straining
  4. Emptying INCOMPLETE
  5. Post-Void Dribbling
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31
Q

Storage (IRRITATIVE) Symptoms: MOST COMMONLY Seen in

A

NEUROGENIC BLADDER

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32
Q

Voiding (OBSTRUCTIVE) Symptoms: MOST COMMONLY Seen in

A

BLADDER OUTLET OBSTRUCTION

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33
Q

⚡⚡ MOST COMMON SYMPTOM OF BPH

⚡⚡ EARLIEST SYMPTOM OF BPH

A

⚡⚡ MOST COMMON & EARLIEST SYMPTOM OF BPH
🎯 FREQUENCY ⬆️⬆️

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34
Q

Which LUTS does not resolve following TURP

A

Post void dribbling

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35
Q

Post Micturial LUTS

A

Incomplete EMPTYING
➕
POST VOID DRIBBLING

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36
Q

Which lobe of PROSTATE affected in Adenoma?
🧠⚡MAD ⚡

A

Median Lobe

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37
Q

Causes of ACUTE RETENTION of URINE

A
  1. BPH
  2. Strictures in URETHRA
  3. Postoperative retention of urine
    ✨ Hemorrhoidectomy
    ✨ Fistulectomy

IN ♀️
1. Hysteria
2. Retroverted Gravid Uterus
3. Urethral stenosis

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38
Q

💊💉 MANAGEMENT of ACUTE RETENTION OF URINE

A

Put FOLEY’S CATHETER (OR) SUPRAPUBIC CATHETER

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39
Q

Definition of CHRONIC RETENTION of Urine

A

≥ 250 ml of RESIDUAL URINE is present chronically

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40
Q

🧑🏻‍⚕️ Clinical Features of CHRONIC RETENTION of URINE

A

NO PAIN
➕
1. Incomplete emptying of Bladder
2. Overflow INCONTINENCE
3. PALPABLE BLADDER
4. Renal Impairment

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41
Q

💊💉 MANAGEMENT of CHRONIC RETENTION

A

Urgent CATHETERIZATION with INTERMITTENT CLAMPING

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42
Q

Rapid Decompression in CHRONIC RETENTION can cause

A

HEMATURIA

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43
Q

Adequate fluid needs to given after POST-OBSTRUCTIVE DIURESIS in CHRONIC RETENTION of urine

A

Dehydration can occur

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44
Q

FIRM RUBBERY PROSTATE is seen in

A

BPH

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45
Q

HARD NODULAR PROSTATE is seen in

A

Cancer

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46
Q

⭐ Mucosa over PROSTATE is MOBILE in

⭐ Mucosa over PROSTATE is FIXED in

A

⭐ Mucosa over PROSTATE is MOBILE in
🎯 BPH

⭐ Mucosa over PROSTATE is FIXED in
🎯 CANCER

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47
Q

USG KUB is done in PROSTATIC pathology for

A
  1. PROSTATIC Volume
  2. Residual Volume
  3. Presence of HYDRONEPHROSIS
  4. Lymph NODE status
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48
Q

Types of FREE PSA
🧠⚡BIP⚡

A
  1. B-PSA (nicked) ➡️ INCREASES in BENIGN Condition
  2. I-PSA (Intact) ➡️ INCREASES in BENIGN condition
  3. Pro-PSA ➡️ INCREASES in PROSTATIC CANCER
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49
Q

Serum PSA = 0-3 ng/ml seen in

A
  1. Normal
  2. BPH
  3. PROSTATITIS
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50
Q

Serum PSA > 3-4 ng/ml seen in

A
  1. BPH
  2. CANCER
  3. PROSTATITIS
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51
Q

🩺 IOC to differentiate BPH & CANCER

A

TRUS guided Truecut BIOPSY

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52
Q

Biopsy for PROSTATE: SAMPLES

A

12 cores taken

✨ Cores taken from
1. Base
2. Mid Part
3. Apex
4. Medial
5. Laterally: LEFT
5. Laterally: RIGHT

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53
Q

COMPLICATIONS of PROSTATIC BIOPSY

A
  1. Hematuria
  2. Hematospermia
  3. Rectal Bleeding
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54
Q

Types of PROSTATIC BIOPSY

A
55
Q

Reduction in PERCENTAGE of FREE PSA indicates

A

PROSTATE CANCER

56
Q

PSA VELOCITY
meaning

A

Change in PSA Value with TIME

57
Q

PSA VELOCITY > 0.75 ng/ml/year indicates

A

PROSTATIC CANCER

58
Q

Approach to LUTS

A
59
Q

Uroflowmetry should be done only if Urine output is

A

> 100 ml

60
Q

Uroflowmetry: Interpretation

A

< 10 ml/s: Bladder Outlet Obstruction
10-15 ml/s: Equivocal
> 15 ml/s: NORMAL

61
Q

Bladder Pressure
Interpretation

A

> 80 cm H2O : High
60-80 cm H2O : Equivocal
< 60 cm : NORMAL

62
Q

Bladder Outlet Obstruction
vs
Neurogenic Bladder

A

✨ Bladder Outlet Obstruction
🎯 ⬆️⬆️ Bladder Pressure
🎯 ⬇️⬇️ Flow Rate

✨ Neurogenic Bladder
🎯 ⬇️⬇️ Bladder Pressure
🎯 ⬇️⬇️ Flow Rate

63
Q

PROSTATISM SANS PROSTATE
(OR)
MARION’S Disease

A

Hypertrophy of Internal Sphincter
⬇️
Features like BPH

64
Q

BPH Features in Young ♂️
➕
Normal Features

A

Marion’s disease
(OR)
Prostatism sans PROSTATE

65
Q

Anatomical Changes occuring in BPH

A
  1. Urethral Lumen ⬇️ ⬇️
  2. Prostatic Urethra lengthened ⬆️
  3. Exaggerated Posterior Curve of Urethra
  4. ⬆️ Pressure in Bladder
    ✨ Bladder Muscle Hypertrophy
    ✨ Trabeculations
    ✨ Diverticula ➕
    ✨ Hydronephrosis
66
Q

🧑🏻‍⚕️ Clinical Features of BPH

A

LUTS

67
Q

Components of BPH

A

⭐ STATIC
🎯 Stromal Hypertrophy DUE TO: DHT

⭐ DYNAMIC
🎯 ⬆️ Smooth Muscle Tone DUE TO: Alpha 1 Receptors

68
Q

Why a Curved Catheter is required for BPH patient

A

Exaggerated Posterior Curve of Urethra

69
Q

IPSS Score used for

A

PROSTATE Hypertrophy

70
Q

IPSS

A

International Prostate System Score
✨ 8 questions are asked, having specific marks

0-7 : Mild BPH ➡️ Observation
8-19: Moderate BPH ➡️ Medical management
20-35: Severe BPH ➡️ Medical (OR) Surgical MANAGEMENT

71
Q

💊💉 Medical MANAGEMENT of BPH

A
  1. Alpha 1a Blockers
    ➡️ Acts on DYNAMIC COMPONENT of BPH
    ➡️ Rapid ONSET
    ✨ Tamsulosin
    ✨ Alfuzosin
  2. 5 alpha Reductase inhibitors
    ➡️ Acts on STATIC Component of BPH
    ➡️ Slow Onset
    ➡️ Sustained Effect
    ✨ Finasteride
    ✨ Dutasteride
72
Q

🤢😳SIDE EFFECTS🥴😵 of ALPHA 1A BLOCKERS

A
  1. 1st DOSE EFFECT
  2. POSTURAL HYPOTENSION
73
Q

Indications of Surgical Intervention in BPH

A
  1. Hydronephrosis
  2. Acute (OR) Chronic Retention of Urine
  3. Multiple episodes of UTI
  4. Gross Hematuria
  5. Diverticula (OR) Stones 2° to BPH
  6. Flow rate < 10 ml/s
  7. Bladder pressure > 80 cm H2O
  8. Not responding to medication
74
Q

Surgical 💊💉 MANAGEMENT of BPH
🧠⚡Minimal: TTH ⚡

A
  1. Minimally Invasive Surgery
    ⭐ TURP: Transurethral Resection of PROSTATE
    ⭐ TULIP: Transurethral Laser Incision of PROSTATE
    ⭐ HOLEP: Holmium Laser Enucleation of PROSTATE
  2. OPEN SURGERY: MILLIN’S APPROACH
75
Q

MILLIN’S APPROACH is used for

A

Open Retropubic Approach for PROSTATE

76
Q

Lasers used for BPH

A
  1. Nd:YAG
  2. KTPA Laser
  3. Holmium Laser
77
Q

⚡⚡ MOST COMMON LASER FOR BPH

⚡⚡ BEST LASER FOR BPH

A

⚡⚡ MOST COMMON LASER FOR BPH
🎯 Nd:YAG

⚡⚡ BEST LASER FOR BPH
🎯 KTPA

78
Q

Hemostatic Lasers

A
  1. KTPA
  2. Holmium
79
Q

Procedure of TURP

A

Go through Urethra with Resectoscope
⬇️
Cut off chips of PROSTATE
⬇️
Deliver them out

80
Q

For Clear Field of Vision during TURP Surgery, what is used

A

Irrigating Fluids
✨ Isotonic Glycine
✨ Distilled Water
✨ 5% Dextrose
✨ NS

81
Q

NS as irrigating fluid can be used only if

A

Bipolar Cautery is being used

82
Q

⬆️ Risk of TURP Syndrome seen with which Irrigating fluids

A

5% Dextrose
Distilled Water

83
Q

Complications of TURP

A
  1. Hemorrhage
  2. TURP Syndrome (OR) Water Intoxication (OR) Dilutional Hyponatremia
  3. Incontinence
  4. Retrograde Ejaculation
  5. Re-operation
  6. Stricture
  7. Clot retentiom
84
Q

⚡⚡ MOST COMMON Complication of TURP during Surgery

⚡⚡ MOST COMMON Complication of TURP following Surgery

A

⚡⚡ MOST COMMON Complication of TURP during Surgery
🎯 Hemorrhage

⚡⚡ MOST COMMON Complication of TURP following Surgery
🎯 Retrograde Ejaculation

85
Q

Cause of HEMORRHAGE in TURP

A
  1. Badenoch’s Artery @5o’clock & 7o’clock
  2. Smaller Flock Arteries @ 10o’clock
86
Q

Clot Retention can be prevented by

A

3 way Foley’s

87
Q

TURP SYNDROME

A

Water gets absorbed from urethra to Blood vessels, about 1 L can move in

88
Q

🧑🏻‍⚕️ Clinical Features of TURP Syndrome

A
  1. Altered Sensorium
  2. Headache
  3. Nausea & Vomitting
89
Q

💊💉 MANAGEMENT of TURP Syndrome

A

⭐ Sodium < 120 mEq/L ➡️ 3% Hypertonic Saline Infusion Gradually

⭐ Sodium > 120 mEq/L ➡️ Fluid Restriction

90
Q

Rapid Correction of Hyponatremia leads to

A

Central Pontine Myelinolysis / Demyelinosis

91
Q

How much Hyponatremia should be corrected per day

A

8 mEq/L

92
Q

Development of TURP depends on

A
  1. Fluid selected for Irrigation
  2. Duration of Surgery
93
Q

⚡⚡ MOST COMMON Site of Urethral Stricture

A

Bladder Neck

94
Q

LASER used for BPH patient, who is on Anticoagulant Therapy

A

KTPA Green Light Laser

95
Q

PIRADS

A

PROSTATE Imaging Reporting And Data System

96
Q

Risk factors for PROSTATE CANCER

A
  1. Age
  2. Testosterone ⬆️
  3. African American Males
  4. Obesity
  5. BRCA2 > BRCA1
  6. Alcohol
  7. Smoking
97
Q

⚡⚡ MOST COMMON GENE Mutated in PROSTATE Cancer

A

GSTP-1
Ch 11
(Glutathione S Transferase Hypermethylation)

98
Q

🩺 IOC for DIAGNOSIS🚦 OF PROSTATIC CANCER

🩺 IOC for SCREENING OF PROSTATIC CANCER

A

🩺 IOC for DIAGNOSIS🚦 OF PROSTATIC CANCER
🎯 TRUS Guided Trucut Biopsy

🩺 IOC for SCREENING OF PROSTATIC CANCER
🎯 DRE ➕ PSA

99
Q

Screening of PROSTATE cancer begins by

A

Annually from 50 yrs age

100
Q

IOC for Staging of PROSTATE CANCER

A

PET-CT

101
Q

mpMRI
Components

A

Multi parametric Prostatic MRI
1. T-stage
2. LN Status
3. Recurrance evaluation
4. Follow up

102
Q

⚡⚡ MOST COMMON Site of Distant Spread of Prostate Cancer

A

Bones
(Vertebral Column ➡️ Lumbar Vertebrae)

103
Q

Type of Metastasis in PROSTATE cancer

A

Osteoblastic > Osteolytic

104
Q

Why Vertebral Column spread in PROSTATE cancer

A

Batsons Plexus of Valveless Veins

105
Q

Indication of BONE SCAN in PROSTATE cancer

A
  1. PSA > 10ng/ml
  2. Gleason’s score ≥ 7
  3. Symptomatic
106
Q

Blackish Deposits on Vertebral Column

A

Metastasis

107
Q

Gleason’s Score

A

Histopathological score used ij PROSTATE cancer

108
Q

How do you differentiate BPH from PROSTATE cancer in H&E?

A

In PROSTATE CANCER ➡️ Myoepithelial cell layer (Bottom layer) of PROSTATE Glands ⛔ (Single cell lined Glands ➕)

✨ Smaller Glands & Back to Back arrangement

109
Q

Gleason Grading of PROSTATE adenocarcinoma

A
110
Q

TNM Staging of PROSTATE

A
111
Q

Staging of PROSTATE cancer done by

A
  1. TNM Staging
  2. Jewish & Whitmore Classification
112
Q

Scores in PROSTATE CANCER used for PREDICTING Recurrence in Prostate Cancer

A
  1. Partin Tables
  2. D’Amico Score
113
Q

Components of Partin Table & D’Amico Score

A
  1. Serum PSA
  2. Clinical Stage
  3. Gleason score
114
Q

💊💉 MANAGEMENT of T1 or T2A PROSTATIC Cancer
⭐ Age < 70 yrs ➕ Expected Life Span > 10yrs ➕ G3/G4/G5 Tumour

⭐ Age > 70 yrs ➕ Expected Life Span < 10yrs ➕ G1/G2/G3

A

⭐ Age < 70 yrs ➕ Expected Life Span > 10yrs ➕ G3/G4/G5 Tumour
🎯 Radical Prostatectomy (Robotic)

⭐ Age > 70 yrs ➕ Expected Life Span < 10yrs ➕ G1/G2/G3
🎯 Observation & Surveillance

115
Q

Structures removed in Radical Prostatectomy

A
  1. Prostate
  2. Seminal Vesicles
  3. Obturator LN
  4. Iliac LN
    ➕
    Anastamose Urethra to Bladder Neck
116
Q

Complication of RADICAL PROSTATECTOMY

A
  1. Sepsis
  2. Erectile Dysfunction
  3. Incontinence
117
Q

Technique used for PROSTATE Cancer Surgery

A

Nerve Preserving RALP (Robot Assisted Laparoscopic Prostatectomy)

Nerve: Cavernous Nerve

118
Q

💊💉 MANAGEMENT of T2B/ T3/ T4 & N0/1 PROSTATIC Cancer

⭐ Age < 70 yrs ➕ Expected Life Span > 10yrs ➕ G3/G4/G5 Tumour

A

Brachytherapy
⬇️
⭐ Good Response: Androgen Deprivation Therapy (ADP) ➕ Observation
⭐ Poor Response: Radical Prostatectomy

119
Q

💊💉 MANAGEMENT of T2B/ T3/ T4 & N0/1 PROSTATIC Cancer

⭐ Age > 70 yrs ➕ Expected Life Span < 10yrs ➕ G1/G2/G3

A

Brachytherapy (Radiotherapy) ± Androgen Deprivation Therapy

120
Q

⚡⚡ MOST IMPORTANT PROGNOSTIC FACTOR FOR PROSTATE CANCER

A

Stage of Disease

121
Q

Radiotherapy in PROSTATE cancer

A
  1. Intensity Modulated Radiotherapy (IMRT): 76-86 Gy
  2. Brachytherapy
122
Q

Which Radioactive Substance is used for Brachytherapy in PROSTATE

A
  1. Iodine 125
  2. Palladium 103
123
Q

Median Survival in Metastatic Prostate Cancer

A

3-5 years

124
Q

Highest Amount of Radiation Exposure for Therapy of Cancer, is given in

A

PROSTATE Cancer
76-86 Gy

125
Q

💊💉 MANAGEMENT of METASTATIC PROSTATE cancer

A

1st Line: Androgen Deprivation Therapy
⬇️
When Tumor becomes RESISTANT to Hormones
⬇️
2nd Line
⭐ Chemotherapy
A. Paclitaxel
B. Cabazitaxel

⭐ T-cell vaccine
Sipleocel-T

⭐ Radiotherapy

126
Q

Androgen Deprivation Therapy
Methods

A
  1. Surgical Castration: B/L Subcapsular Orchidectomy
  2. Medical Castration:
    LHRH Analogue ➕ Anti-androgens
    ✨ Goserelin
    ✨ Buserelin

Anti-androgens
✨ Flutamide
✨ Enzalutamide
✨ Abiraterone

LHRH Antagonist
✨ Degarelix

127
Q

Why LHRH Analogues combined with Anti-androgens?

A

In Initial Days, Testosterone ⬆️ ⬆️
⬇️
PSA Flare

✨ To prevent PSA Flare

128
Q

T-cell Vaccine used for

A

Prostate Cancer
✨ Sipuleocel T (Provenge)
✨ CD54 Extract

129
Q

Radio pharmaceutical Therapy used for

A

Resistant Bony METASTATIS in PROSTATE cancer

130
Q

Radio pharmaceutical Therapy done with

A
  1. Strontium 89
  2. Radium 223
131
Q

Perineural Invasion is seen with which CANCER?
🧠⚡3P⚡

A
  1. PROSTATIC Adenocarcinoma
  2. Pancreatic Carcinoma
  3. Parotid Gland tumour: Adenoid Cystic Carcinoma
132
Q

E-Cadherin ASSOCIATED Tumours

A
  1. Lobular Carcinoma of Breast
  2. Gastric adenocarcinoma
  3. PROSTATE adenocarcinoma
133
Q

Tumour MARKER for PROSTATIC CARCINOMA

A

PSA
Organ specific NOT Tumour specific

134
Q

IHC Marker for PROSTATE cancer

A
  1. AMACR: Alpha Methyl Acyl Conenzyme A Racemose
  2. TMPRSS2-ERG Fusion DNA
  3. PCA3

UROLOGY (12 decks)

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