prostate

Question 1

common causes LUTS in men

Answer 1

PBH or prostate cancer

Question 2

voiding symptoms LUTS

Answer 2

hesitance, poor stream, straning, incomplete emptying, dribbling

Question 3

storage symptoms LUTS

Answer 3

urgency, frequence, nocturia , incontinence

Question 4

post-micturation LUTS symptoms

Answer 4

dribbling eg in pants, feeling incomplete

Question 5

invx LUTS

Answer 5

urinalysis // PR // PSA

Question 6

what scoring system affects LUTS affect on daily life

Answer 6

IPSS

Question 7

mx voiding LUTS symptoms

Answer 7

physio // alpha blocker eg doxasocin,tamulosin // 5a reductase eg finasteride // anticholinergic eg Oxybutynin

Question 8

mx overactive bladder (urge)

Answer 8

reduce fluid // bladder retraining // oxybutiin, tolterodine // mirebegron

Question 9

mx nocturia LUTS

Answer 9

furosomide 40mg // desmopressin

Question 10

symptoms BPH

Answer 10

LUTS (weak flow, straining, dribbling, hesitancy, urgency, frequency, nocturia, post-mic dribbling)

Question 11

complications BPH

Answer 11

UTI, retention, obstrictive

Question 12

invs BPH

Answer 12

urinalysis // U+Es // PSA // urinary frequency // IPPS

Question 13

medical mx PBH

Answer 13

1 = alpha antagonist eg tamulosin // 2 = 5alpha eg

Question 14

medical mx PBH

Answer 14

1 = alpha antagonist eg tamulosin // 2 = 5alpha eg finasteride // 3 = combination of alpha 5a if voiding symptoms // 3 = alpha + anticholinergic if storage and voiding

Question 15

mechanism + SE alpha antagonists

Answer 15

decrease smooth muscle tone of bladder and prostate // dizzy, postural hypotension, dry mouth, depression

Question 16

mechanism + SE 5a reductase inhibitors

Answer 16

block testosterone –> DHT (causes BPH) // ED, reduced libido, ejaculation problems, gynaecomastia

Question 17

when are 5a reducatase inhibitors indicated in BPH

Answer 17

significantly large + progressing prostate // symptoms can take 6 months to resolve

Question 18

surgery for BPH

Answer 18

transurethral resection (TURP)

Question 19

complications TURP

Answer 19

haemorrhage, retrograde ejaculation, TURP syndrome

Question 20

what causes TURP syndrome

Answer 20

glycine irrigation in TURP –> hyponatraemia, hyperammonia

Question 21

symptoms TURP syndrome

Answer 21

CNS, respiratory, systemic symptoms, visual disturbance

Question 22

RF TURP syndrome

Answer 22

surgery >1hr // large resection // large blood loss // perforation // poorly controlled CHS

Question 23

RF prostate cancer

Answer 23

age, obese, black, FH

Question 24

possible symptoms prostate cancer

Answer 24

bladder outflow obstruction (hesitancy, retention) // haematuria, haematospermia // pain (back, balls, perineal)

Question 25

what causes PSA to rise

Answer 25

Cancer // prostatitis, UTI, BPH, retention // recent ejaculation // exercise // catheter

Question 26

what PSA warrants referall

Answer 26

aged 50-69 >3 OR abnormal PR

Question 27

invx prostate cancer

Answer 27

MRI

Question 28

what scale is used for reporting prostate cancer

Answer 28

5‑point Likert scale

Question 29

when is trans rectal USS + biopsy offered in prostate cancer

Answer 29

after MRI if score >3

Question 30

most common prostate cancer

Answer 30

adenocarcinoma (95%)

Question 31

what scoring is used for prognosis in prostate cancer

Answer 31

gleason (2 = good --> 10 = bad)

Question 32

which zone do prostate cancers usually arise

Answer 32

peripheral

Question 33

which nodes are often first affected prostate cancer

Answer 33

obturator (+ pelvic nodes)

Question 34

common mets prostate

Answer 34

bone!! spinal back pain can be first symptoms

Question 35

mx local prostate cancer (T1-2)

Answer 35

active monitoring // radical prostatectomy // radio

Question 36

mx local advanced prostate cancer (T3-4)

Answer 36

hormone therapy // radical prostatectomy // radiotherapy

Question 37

complication radical prostaectomy

Answer 37

erectile dysfunction

Question 38

complication prostate radiotherapy

Answer 38

increased risk: bladder, colon, rectal

Question 39

mechanism GnRH agonists + example

Answer 39

Goserelin // lower LH levels by overstimulating receptors

Question 40

what happens in the initial few weeks of GnRH analogue therapy

Answer 40

rise in testosterone --> can cause tumour flare

Question 41

what needs to be given during the first few weeks of GnRH agonists in prostate cancer

Answer 41

anti-androgen therapy

Question 42

mechanism bicalutamide prostate cancer

Answer 42

non-steroids anti-androgen // blocks androgen receptors

Question 43

mechanism cyproterone acetate prostate cancer

Answer 43

steroidal anti-androgen // prevents DHT from binding

Question 44

mechanism abiraterone prostate cancer

Answer 44

androgen sythesis inhibitor

Question 45

surgical hormone option protestatic cancer

Answer 45

bilateral orchidectomy