prostate Flashcards
BPH is
benign prostatic hyperplasia
very common affecting men over 50 years
hyperplasia of stromal and epithelial cells of prostate
BPH presents with
There are typical lower urinary tract symptoms (LUTS) that occur with prostate pathology:
Hesitancy
Weak flow
Urgency
Frequency
Intermittency
Straining to pass urine
Terminal dribbling
Incomplete emptying
Nocturia
BPH investigation
rectal
penis
abdominal
urinary frequency volume chart
MSSU
urine disptick
prostate specific antigen- if raised then TRUS guided biopsy
renal tract US
BPH management
Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms
5-alpha reductase inhibitors (e.g., finasteride) gradually reduce the size of the prostate, reduces testosterone
transurethral resection of prostate TURP- gold standard
open prostatectomy
watch and wait asymptomatic
BPH management
Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms
5-alpha reductase inhibitors (e.g., finasteride) gradually reduce the size of the prostate
transurethral resection of prostate TURP
open prostatectomy
zones of prostate
transition
central
peripheral
anterior fibromuscular stroma
BPH affects what zone
transition
short term catheters should not be left in for more than
4 weeks
long term catheters should not be left in for more than
12 weeks
bladder outflow obstruction management
cystolithiolapaxy and TURP
or nothing or catheterisation
acute urinary retention treatment
catheterisation and alpha blocker
remove catheter in 2 days
2nd time- TURP
treat underlying cause
acute urinary retention signs
painful and percussible bladder, inability to void. can lead to haematuria
chronic urinary retention signs
painless, palpable and percussible after voiding. can lead to haematuria
chronic urinary retention managment
if symptomatic- catheterisation, IV fluids, CISC or TURP, long term catheter
prostate cancer epidemiology
commonest in men, 3rd commonest cause of cancer death
RFs for prostate cancer
genetics, obesity and diet, age, tall, black african or caribbean, anabolic steroids
diagnosis of prostate cancer
usually asymptomatic and opportunistic
if locally invasive- haemturia, incontinence, loin pain, renal failure, haemospermia, rectal symptoms
systemic symptoms eg bone pain, lethargy etc
PSA ranges for age
less than 50: 2.5 is upper limit
50-60: 3.5 “
60-70: 4.5 “
70 plus: 6.5 upper limit
cancer has persistent rise, should check at least 3 weeks
investigations for prostate cancer
PSA
rectal DRE
MRI multiparametric (first line for suespcted localised cancer)
biopsy (2nd line for establishing)
grading for cancer
gleason sum score 3-5 (5 is worst)
or ISUP 1-5
TNM staging
localised treatment for prostate cancer
watch and wait
radiotherapy
radical prostatectomy
ablative
hormone therapy (testosterone)
what zone is mainly affected by cancer
peripheral zone
what is prostate specific antigen
glycoprotein that is secreted in the semen, with a small amount entering the blood. Its enzymatic activity helps thin the thick semen into a liquid consistency after ejaculation. It is specific to the prostate, meaning it is not produced anywhere else in the body. A raised level can be an indicator of prostate cancer.
prostatitis signs and symptoms
fever
malaise
dysuria
urinary frequency
pelvic pain
swelling of acutely inflamed prostate
prostatitis treatment
ciprofloxacin 500mg twice daily
ofloxacin 200mg twice daily second line
