prostate Flashcards
common causes LUTS in men
PBH or prostate cancer
voiding symptoms LUTS
hesitance, poor stream, straning, incomplete emptying, dribbling
storage symptoms LUTS
urgency, frequence, nocturia , incontinence
post-micturation LUTS symptoms
dribbling eg in pants, feeling incomplete
invx LUTS
urinalysis // PR // PSA
what scoring system affects LUTS affect on daily life
IPSS
mx voiding LUTS symptoms
physio // alpha blocker eg doxasocin,tamulosin // 5a reductase eg finasteride // anticholinergic eg Oxybutynin
mx overactive bladder (urge)
reduce fluid // bladder retraining // oxybutiin, tolterodine // mirebegron
mx nocturia LUTS
furosomide 40mg // desmopressin
symptoms BPH
LUTS (weak flow, straining, dribbling, hesitancy, urgency, frequency, nocturia, post-mic dribbling)
complications BPH
UTI, retention, obstrictive
invs BPH
urinalysis // U+Es // PSA // urinary frequency // IPPS
medical mx PBH
1 = alpha antagonist eg tamulosin // 2 = 5alpha eg
medical mx PBH
1 = alpha antagonist eg tamulosin // 2 = 5alpha eg finasteride // 3 = combination of alpha 5a if voiding symptoms // 3 = alpha + anticholinergic if storage and voiding
mechanism + SE alpha antagonists
decrease smooth muscle tone of bladder and prostate // dizzy, postural hypotension, dry mouth, depression
mechanism + SE 5a reductase inhibitors
block testosterone –> DHT (causes BPH) // ED, reduced libido, ejaculation problems, gynaecomastia
when are 5a reducatase inhibitors indicated in BPH
significantly large + progressing prostate // symptoms can take 6 months to resolve
surgery for BPH
transurethral resection (TURP)
complications TURP
haemorrhage, retrograde ejaculation, TURP syndrome
what causes TURP syndrome
glycine irrigation in TURP –> hyponatraemia, hyperammonia
symptoms TURP syndrome
CNS, respiratory, systemic symptoms, visual disturbance
RF TURP syndrome
surgery >1hr // large resection // large blood loss // perforation // poorly controlled CHS
RF prostate cancer
age, obese, black, FH
possible symptoms prostate cancer
bladder outflow obstruction (hesitancy, retention) // haematuria, haematospermia // pain (back, balls, perineal)
what causes PSA to rise
Cancer // prostatitis, UTI, BPH, retention // recent ejaculation // exercise // catheter
what PSA warrants referall
aged 50-69 >3 OR abnormal PR
invx prostate cancer
MRI
what scale is used for reporting prostate cancer
5‑point Likert scale
when is trans rectal USS + biopsy offered in prostate cancer
after MRI if score >3
most common prostate cancer
adenocarcinoma (95%)
what scoring is used for prognosis in prostate cancer
gleason (2 = good –> 10 = bad)
which zone do prostate cancers usually arise
peripheral
which nodes are often first affected prostate cancer
obturator (+ pelvic nodes)
common mets prostate
bone!! spinal back pain can be first symptoms
mx local prostate cancer (T1-2)
active monitoring // radical prostatectomy // radio
mx local advanced prostate cancer (T3-4)
hormone therapy // radical prostatectomy // radiotherapy
complication radical prostaectomy
erectile dysfunction
complication prostate radiotherapy
increased risk: bladder, colon, rectal
mechanism GnRH agonists + example
Goserelin // lower LH levels by overstimulating receptors
what happens in the initial few weeks of GnRH analogue therapy
rise in testosterone –> can cause tumour flare
what needs to be given during the first few weeks of GnRH agonists in prostate cancer
anti-androgen therapy
mechanism bicalutamide prostate cancer
non-steroids anti-androgen // blocks androgen receptors
mechanism cyproterone acetate
prostate cancer
steroidal anti-androgen // prevents DHT from binding
mechanism abiraterone
prostate cancer
androgen sythesis inhibitor
surgical hormone option protestatic cancer
bilateral orchidectomy
