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Semester 4 (NME) > Prostate > Flashcards

Prostate Flashcards

1
Q

Which hormone is more potent? DHT or testosterone?

A

DHT (5-10x more)

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2
Q

What enzyme in the prostate converts testosterone to DHT?

A

Steroid 5-alpha-reductase

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3
Q

What effect does DHT have on the prostate?

A

Stimulates stromal tissue growth

Stimulates acini growth

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4
Q

What effect does oestrogen have on the prostate?

A

Primes androgen receptors

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5
Q

Are DHT levels increased in BPH?

A

NO

It’s the receptors which are increased (possibly due to oestrogen)

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6
Q

Why does prostate growth constrict the urethrea?

A

As the prostate is surrounded by a fibrous capsule, so growth of the prostate increases pressure

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7
Q

What is Retrograde ejaculation?

A

Where semen enters the bladder rather than being ejected via the urethra

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8
Q

What aspect of semen gives the prostate it’s antimicrobial properties?

A

Zinc

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9
Q

What is the function of PSA?

A

Causes semen coagulation in the cervix then liquidation after when needed (it’s a protease)

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10
Q

How does prostate growth change with age?

A

Growth and doubling time increase with age

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11
Q

What is the difference between BPE and BPH?

A

BPE is an clinical diagnosis

BPH is a pathological diagnosis

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12
Q

Name 6 risk factors for BPH

A

Age, obesity, diabetes, genetics, dyslipidaemia, androgen levels

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13
Q

Name 4 factors which can decrease risk of BPH?

A

Castration
Weight loss
Mod/ severe exercise
Reduce cardiovascular risk

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14
Q

What is the clinical prevalence of BPH between 40-49 and 70-79?

A

40-49: 14%

70-79: 40%

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15
Q

What is the link between clinical prevalence of BPH and the autopsy prevalence between ages 70-80?

A

Autopsy prevalence is roughly double that of the clinical prevalence

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16
Q

Use of 5-alpha-reductase inhibitors will cause what change in prostate size over 1yr? Name another use of these drugs?

A

25% size reduction

Another use: Causes hair growth

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17
Q

What changes in flow are observed when medication is used to treat BPH?

A

Small improvements in flow but not much

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18
Q

What are the two categories of LUTS symptoms?

A

Storage- nocturia/ urgency/ incontinence
Voiding- Poor flow/ intermittent/ incomplete voiding/ dribbling/ straining
Around 50% P have both S+V symptoms

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19
Q

What are the 3 most common complication of BPH?

A 
Renal failure (2.5%)
Bladder calculi (0.3-3.4%)
Infection (1-12%)
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20
Q

What are 3 disadvantage to use of 5-alpha- reductase inhibitors?

A

Take -6mnths to start working
Can cause gynaecomastia + sexual dysfunction
Reduces PSA

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21
Q

What is the NICE pathway for BPH treatment?

A

Alpha blockers
5 alpha reductase blocker
Combine alpha block and 5-a-reducatase blocker
Surgery

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22
Q

What is the most common surgical treatment for BPH?

A

Trans-urethral resection of prostate (TURP)

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23
Q

What is the most common complication of TURP surgery?

A 
Retrograde ejaculation (70%) 
10%- recurrence rate 
Erecticle dysfunction (5%)
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24
Q

What are the 5 anatomical prostate regions?

A 
Peri-urethral 
Transition
Peripheral 
Central
Anterior Fibromuscular
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25
Q

What is the most common cancer in men?

A

Prostate cancer (Make up 25% of M cancers)

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26
Q

What ethnicity is affected most by prostate cancer?

A

Afro-carribean (2-3x more likely)

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27
Q

Which gene is implicated in development of prostate cancer?

A

BRCA2 (look for breast cancer in mother) -5x increased risk

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28
Q

What is the prevalence of urinary incontinence in M and F over the age of 80?

A

M: 34%
F: 46%

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29
Q

Most hyperplasia’s of the prostate arise in which zone of the prostate?

A

Transitional

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30
Q

Most carinoma’s of the prostate arise in which zone of the prostate?

A

Peripheral (The biggest zone- 70%)

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31
Q

What is the histological composition of the glands within the prostate?

A

Basal layer of low cuboidal epithelium covered by columnar secretory cells

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32
Q

What controls the growth and survival of prostate cells?

A

Testicular androgens

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33
Q

(Type 2) 5-alpha-reductase is responsible for what?

A

Conversion of testosterone to DHT (in the stromal cells of the prostate)

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34
Q

What are the contents of prostatic fluid?

A

PSA
Sperminin (helps motility)
Proteolytic enzyme

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35
Q

At what volume will the bladder create enough pressure to force pass the IUS/EUS to force micturation?

A

500ml

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36
Q

Which metastasis is exclusive to prostate cancer?

A

Osteosclerosis

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37
Q

What is PSA a test for?

A

Detection of prostate disease (any prostate disease)

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38
Q

Name a problem with PSA screening?

A

We detect many cancers which would never be a problem therefore we overtreat. We can also miss some cancers.

39
Q

Where is the EUS found?

A

In the deep perineal pouch (in the pelvic floor)

40
Q

Name the 4 parts of the male urethra

A 
Preprostatic
Prostatic
Membranous (intermediate)- Surrounded by skeletal muscle (EUS)
Spongy- Surrounded by corpus spongiosum
41
Q

What artery/veins supply the urethra?

A

Inf vesical art/vein
Middle rectal art/vein
Pudendal art/vein

42
Q

Where does lymph from the urethra drain?

A

Internal iliac LN’s

43
Q

Give the description and relations of the prostate gland

A

Accessory structure of M reproductive system
Inf to bladder
Ant to rectum, post to pubic symphisis

44
Q

What is the shape of the prostate?

A

Inverted cone with large base (connected to bladder) and an narrow apex below the pelvic floor.
The two inferiolateral surfaces are in contact with the pelvic floor

45
Q

Where do the glands in the prostate drain to?

A

The prostate sinuses (in prostatic part of urethra)

46
Q

What does the anterior fibromuscular region of the prostate consist of?

A

Smooth muscle and fibrous tissue

47
Q

Which regions of the prostate contain most glands?

A

Central and peripheral regions

48
Q

What structure contains the prostate and causes build up of pressure on the urethra when the prostate grows?

A

Fibrous capsule around prostate

49
Q

Which enzyme converts testosterone to DHT in the prostate?

A

Type II 5-alpha reductase

50
Q

Which zone of the prostate gland surround the urethra?

A

Transition Zone

51
Q

Which enzyme activates PSA?

A

Human kallikrien 2 (hK2)

52
Q

Name 4 causes of cloudy urine:

A

Kidney damage (leaked proteins)
UTI or bladder infection
Kidney stones
Sperm (retrograde ejaculation) or vaginal discharge

53
Q

What is a dynamic isotope renogram?

A

Radioactive compound injected into venous system and gamma camera is used to measured clearance
Allows monitoring of kidney function

54
Q

What do patients with kidney damage experience anaemia?

A

Lowered EPO production

55
Q

Where is PSA produced?

A

Epithelial prostatic cells

56
Q

How do PSA levels change with age?

A

Rise

so must always correct levels for age

57
Q

Name 5 pathological causes of raised PSA?

A

BPH
Acute urinary retention/ urinary catheter insertion
Prostatis
Prostatic cancer

58
Q

What is the pathophysiology of nephrolithiasis?

A

‘Casts’- small blood clots/ cells/ lipids form in the collecting ducts, these are then mineralised to form stones

59
Q

What is hydronephrosis, what symptoms would accompany it?

A

Dilation of renal calyces due to progessive atrophy
(Cause long term renal hypertension)
- Severe pain in back/side between ribs and hip

60
Q

What are the common causes of hydronephresis? (5)

A

Kidney stones
BPH/ prostate cancer
Pregnancy
Bladder cancer

61
Q

What is neurogenic bladder dysfunction? What are some common symptoms?

A

Involuntary release from full bladder
- Constant overflow dribbling
- Often also erectile dysfunction in M
(Large post void residual volume confirms Diagx)

62
Q

What are the three regions of the ureters most likely to contain a kidney stone?

A

1- Uretopelvic junction
2- Pelvic inlet
3- Entrance to bladder

63
Q

In which prostatic region is the internal urethral sphincter found?

A

Pre-prostatic

64
Q

What features of a DRE suggest BPH rather than prostatic cancer?

A

Firm (but not hard)

Smooth (not nodular)

65
Q

What features of the prostate gland suggest carcinoma?

A

Hard not firm

Nodular

66
Q

What tests could be done to help diagnose BPH?

A 
PSA antigen (corrected for age)
Urine analysis(infection/ haematuria)/ flow measurement
Ultrasound 
Abdo exam (palpable bladder)
67
Q

What is IPSS?

A

International prostate system score
0-7 = Mild symptoms
20-35= Severe symptoms

68
Q

What should the first line response be to BPH with mild symptoms where malignancy has been excluded?

A

Watchful waiting

69
Q

How do alpha-1a antagonists work?

What P are offered these drugs?

A

Treat symptoms of retention
Reduce muscle tone in neck of bladder
- Px offered if IPSS > 8

70
Q

Name 5 alpha-1 antagonist drugs:

A 
Tamsulosin (Specific to alpha 1a)
Prazosin
Doxazocin
Terazocin
Alfuzocin
71
Q

Name two 5-alpha reductase blockers:

A

Finasteride

Dutasteride

72
Q

What is a normal creatinine clearance?

A

60-180ml/min

73
Q

Presence of both protein and blood on a urine dipstick is confirmation of:

A

Kidney disease

74
Q

When male to male transmission is seen an an inherited disease what type of disease can it not be?

A

X-Linked

75
Q

What is pyelonephritis?

A

Inflammation of the kidney as a result of bacterial infection.

76
Q

What is the most common inherited cause of serious renal disease and how is it transmitted?

A

Polycystic kidney disease
Autosomal dominant
PKD1 and PKD2 genes

77
Q

What is the most common presentation of Px with PKD?

A

Failure to concentrate urine (fluid loss)
Nocturia/ haematuria
Loin pain
Kidney enlargement/ hypertension

78
Q

What is the definition of BPH?

A

Increased size of prostate with no malignancy present

Likely to be failure of apoptosis

79
Q

What is the most common age and ethnicity of presentation in BPH?

A

Over 60’s (Age single biggest risk factor)

Afro-carribean

80
Q

BPH affects the QoL of X% of people in their 50’s and Y% of people in their 90’s?

A 
X= 40%
Y= 90%
81
Q

What is the pathophysiology of BPH?

A

Increased proportion of oestrogen with age (due to less testosterone)
This leads to upregulation of DHT androgen receptors

82
Q

Name 8 symptoms of BPH?

A

Nocturia/ urinary retention/ poid void dribbling
Dificulty in initiating micturation/ variability in force
Haematuria/ pain on urination/ cloudy urine (severe)
CKD symptoms

83
Q

What is the definition of incontinence?

A

Inability to voluntarily control urination

84
Q

Why can incontinence been seen in diseases such as Alzehimers?

A

Loss of CNS inhibition so micturation reflex remains automatic

85
Q

By what process does urine move down the ureter from the kidney to the bladder?

A

Peristalsis

ureter approx 30cm long

86
Q

How do the ureters pass into the bladder and why is this?

A

Through a slit

- Helps prevent backflow

87
Q

What is the uretorenal reflex?

A

Pain in ureter causes constriction of renal arterioles to reduce flow into the kidney (and therefore out in urine)

88
Q

What is a self regenerative contraction?

A

Initial contraction causes further contractions

89
Q

What is thought to be the cause of decreased apoptosis in BPH?

A

Increased androgen stimulation (via increased numbers of receptors)

90
Q

Where is the enzyme T2 5 alpha reductase found?

A

Stromal cells of prostate

91
Q

Where does DHT bind?

A

Nuclear androgen receptor (AR) present in both stromal and epithelial prostate cells

92
Q

What effects does DHT have when it binds to it’s receptor?

A

Upregulates growth factors and their receptors

E.g FGF-7/ FGF-1/2 and TGFbeta

93
Q

Why do patients with BPH experiences increased numbers of UTI’s?

A

Retained urine acts as a reservoir for bacteria growth as it is not cleared

94
Q

Name 5 things found in the secretions of the prostate gland?

A 
Simple sugars (99%)
Protease enzymes (including PSA)
Prostatic acid phosphatase 
Beta-microseminoprotein (immunoglobulin)
Zinc (anti-microbial)

Semester 4 (NME) (24 decks)

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