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FERGU > Prostate > Flashcards

Prostate Flashcards

1
Q

Prostate cancer presentation

A

rarely symptomatic
PSA & DRE detection
large/extensive - obs
metastasize to bones: back pain

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2
Q

BPH symptoms

A

obs: hesitancy, decreased force of stream, incomplete voiding, straining, post void dribbling
- can be dynamic or mechanical
irritative: frequency, urgency, nocturia
- response of bladder to increased resistance - detrusor hyperplasia & hypertrophy, collagen deposition

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3
Q

Prostatitis Sx

A 
dysuria
frequency
urgency
fever
chills
malaise
perineal/back/rectal pain
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4
Q

DDx of prostatic nodules

A 
Malignancy ~25%
BPH (most common)
calculus (very common)
Infarction
cyst
tuberculous/chronic granulomatous
previous TURP-biopsy scar
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5
Q

Screening for prostate cancer

A

early asymptomatic, detected by PSA

DRE - usually detect more advanced (>T2)

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6
Q

PSA screening guideline

A

Not recommended unless risk factors present, or monitoring rise after age >50
Risk factors: African-Am, fam Hx (1st degree), age ( >55 normal, >50 risk), previous abnormal biopsy
Prostate CA can also present with low PSA
elevated in infection, BPH, inflammation, manipulation of prostate - need to wait 2 weeks after DRE

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7
Q

PSA level

A

worry when >4
>10 high risk for cancer
velocity rise >0.75/yr

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8
Q

BPH assessment

A

US for bladder, kidney assessment
PE for prostate
catheterization

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9
Q

Congenital abnormality assessment

A

UPJ, posterior urethral valves

US first line for children

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10
Q

Anuria with rising creatinine assessment

A

differentiate btw surgical vs medical renal failure
surgical: obs of both kidneys, bladder obs due to BPH, bladder cancer, urethral stricture
US and catheritization

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11
Q

Sepsis, UT obs assessment

A

catheterization
cultures , electrolytes, creatinine
US for hydronephrosis
drainage via retrograde stent or pc nephrostomy

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12
Q

Terazosin/Doxasozin

A

fast alpha1 blocker (selective)

SE: dizziness, fatigue, rhinorrhea, ED

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13
Q

Tamsulosin, alfuzosin, silodosin

A 
alpha1 subtype A selective
less SEs than other alpha blockers
retrograde ejaculation (Tamsulosin), orthostatic hypotension
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14
Q

alpha blocker for BPH

A

All similar in efficacy
SEs; CV problems, dizziness, ejaculatory

safe in elderly
need to titrate with anti-HTN meds
subtype A selective meds do not require titration

interaction with PDE5is - mild hypotension, not a concern with selective blockers

long-term use: prostate continues to grow, most grow resistant

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15
Q

5-alpha reductase inhibitors

A

Blocks prostate growth fueled by DHT
blocks testosterone –> DHT
slower onset of action than alpha blockers

Dutasteride - blocks both
Finasteride - blocks type II - reduce incidence of AUR in surgery in men with large prostate

Prostate CA risk: 25% reduction in dx of low risk cancers
high risk cancers detected more readily

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16
Q

Combination therapy for BPH

A

alpha blockers + 5-alpha reductase inhibitors
reduce risk of AUR
decrease cumulative incidence of BPH
reduce BPH-related surgery (mostly finasteride)
may also combine with anticholinergics, PDE5is

Indications: men with BPH AND:

  • LUTS
  • elevated prostate volume (>30cc)
  • elevated PSA (>1.4)
  • moderate-severe bother
17
Q

PDE5i

A

relax smooth muscle
decrease symptoms, no effect on flow
SEs: erections

18
Q

Anticholinergics - BPH

A

relax bladder muscle (helpful after removing obs)

decrease symptoms, no effect on flow

19
Q

Minimally invasive surgery for BPH

A

botox, alcohol injections
photodynamic surgery (reduce blood supply)
microwave heat
radiowave ablation

20
Q

TURP

A

GOLD STANDARD
3-6 weeks of recovery - hematuria, painful urination

Early risks: retrograde ejaculation (70%)
transfusion for hematuria (10%)
injury - rare
prolonged retention (10%)
infection, incontinence rare
prolonged hematuria
obs
loss of erection

Late risks:
10-15% will need TURP again in 10-15 yrs

21
Q

Open prostatectomy

A 
Indications:
urinary retention refractory to treatment
recurrent UTI
renal compromise
hematuria
bladder stones
22
Q

Dx of prostate cancer

A

abnormal PSA/DRE –> biopsy
indications: suspicious DRE, abnormal PSA (>4 or increasing >0.75/y)
10 core sampling
Gleason score & grading (2-6 low, 7 intermediate, 8-10 high risk)

trans-rectal US not specific/sensitive enough (CA often mutlifocal & heterogenous) - use in guide for biopsy, estimate size for BPH

23
Q

Staging of prostate cancer

A

PSA
Bone scan - only high risk/bone pain
CT - only high risk

high risk: PSA > 20, Gleason score 8-10, T3

24
Q

TNM for prostate ca

A

T1 a/b - TURP only, c - biopsy
T2: palpable on DRE and confined to gland
T3: palpable beyond prostate
T4: well beyond prostate

25
Q

Tx for prostate cancer

A

Goal: active surveillance Gleason 2-6 , low risk, Stage up to T2a

Surgery: radical prostatectomy
radiotherapy
watchful waiting
hormonal therapy

26
Q

Radical prostatectomy

A

Retropubic: minimal post-op morbidity, no spinal/epidural required
Perineal: obese, other contraindications, higher rates of adverse outcomes

27
Q

Complications of surgery

A

Intraoperative - bleeding, dmg to obturator, rectal injury, dmg to ureters and seminal

Postoperative - incontinence, ED - want to spare Neurovascular bundles of Walsh (2 spared - 50-60% erections, 1 spared - 20%)

28
Q

Radiation therapy for prostate CA

A

localized
Internal: brachytherapy - radiation source into prostate (low risk)

External: IMRT and proton beams - high risk patients, beams of radiation aimed at tumour location, effects on adjacent tissues (effect on bladder and rectum)

29
Q

Active surveillance for prostate CA

A

localized cancer, low risk

periodic DRE and PSA measurements, repeat biopsies

30
Q

Hormonal therapy for prostate CA

A

Standard in localized advanced and metastatic
adjuvant with radiation possible
after failure of radiotherapy

Bilateral orchiectomy
GnRH analogues - initial surge in testosterone but downregulation of GnRH receptors on pituitary surface, reduction in LH, reduction in testosterone
GnRH antagonists - block GnRH receptor on pituitary - no testosterone flare
Progestational/estrogenic agonists - severe side effect profile (CV, thrombosis, feminization)
Anti-androgens: competitive inhibition of androgen receptor, not used as monotherapy, combine wiht GnRH analogue to prevent flare

31
Q

Castration resistance

A

prostate develops ability to grow even without testosterone

32
Q

Chemotherapy for prostate CA

A

Docetaxel (taxel)

standard therapy used in hormone resistant tumours that are metastatic

FERGU (14 decks)

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