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Prostate Flashcards

1
Q

What (7) is in international prostate symptom score?

A
  • Frequency
  • Nocturia
  • Urgency
  • Intermitency
  • Incompete bladder emptying
  • Weak stream
  • Straining

Each is ranked from 1-5. Used to see progression of symptoms

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2
Q

What would you feel in DRE of BPH?

A

Symmetrical enlargement of prostate

Not lumpy or nodular

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3
Q

Ix for someone with LUTS that may be related to prostate pathology

A 
Urine dipstick
Urinalysis MSU MCS + cytology
UEC (renal function)
24 hour voiding 
Urodynamic study - for flow strength. 
Post void residual ultrasound
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4
Q

What can increase PSA?

A 
BPH
prostate cancer
UTI
Prostatitis
Epididymitis
IDC, TURP
bike riding
recent ejaculation
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5
Q

(3) Pharmacological Mx of BPH
- indication
- SE

A
  1. Dutasteride: 5 Alpha reductase inhibitor -> decreases DHT (SE: low libido, impotence). Hence not suitable for younger males.
  2. Tamsulosin: alpha 1 adrenoceptor blocker (smooth muscle relaxant. SE: postural hypotension) Hence they should take it at night before going to bed.

Duodart: combination of dutasteride & tamsulosin.

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6
Q

(3) SE & (2) Cx of TURP

A
  • Haematuria
  • Temporary Dribbling, Urgency
  • Retrograde ejaculation (if bladder neck is resected)

Cx: stricture, UTI

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7
Q

(7) Precipitants of acute urinary retention

A
  1. Diuresis +/- alcohol
  2. Alpha stimulant drugs (e.g. phenylepharine).
  3. Antimuscularinic (e.g. Tiotropium)
  4. Acute constipation
  5. Prostate enlargement/prostatitis
  6. Neurological problem
  7. Stones
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8
Q

What is the difference between acute & chronic urinary retention?

A

Acute: painful
Chronic: painless

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9
Q

How common is prostate cancer?

A

15% by the age of 85yo

No. 1 male malignancy in some races
No. 2 cause of death by malignancy

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10
Q

What type of cancer is prostate cancer?

A

Adenocarcinoma

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11
Q

What is the prognosis of prostate cancer?

A

5-10 year survival is great (~70%) but terrible at 15 year survival

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12
Q

Px of prostate cancer

A

Bony mets - spine (back exam). BBLL: bone breast liver lungs
LOW
Sciatica
Anaemia

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13
Q

Ix of prostate cancer

A

DRE - harder, nodular
PSA - a rising trend is a concern not a one off.
Biopsy:
- TRUS (transrectal US guided biopsy) + Prophylactic antibiotics & pre-procedural enema to clear bowel lumen. SE: sepsis.
- Transperineal biopsy +/- grid

Bonescan, CT, MRI for staging (metastasis)

Image ONLY for metastasis (not for prostate)

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14
Q

What is normal range of PSA?

A

2ng/ml at 40’s with increase by 1 every decade.

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15
Q

Describe Gleason Score

  • score out of …
  • Methodology of scoring system
  • interpretation
A

Pathological score out of 10

Pick 2 biggest areas affected of prostate (as prostate cancer is heterogenous)

Tissue area each is graded out of 5 (where 5 is the worst differentiations & 1 is the closest to normal).

Hence Gleason score = score from area A + score from area B

G2-6: low risk
G7: (3+4) or (4+3). Quite common. Moderate risk
G8-10: high risk

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16
Q

How do you stage Prostate cancer?

A

TNM
T1: non palpable & not visible on radiology (like BPH. Everyone who has a TURP gets a biopsy - hence common incidental finding)
T2: palpable
T3: extracapsular. Invasion to seminal vesicle
T4: local invasion other than seminal vesicle. E.g. bladder, rectum, sphincters

N0: none
N1: nodes present

M0:
M1: metastasis by venous supply -> axial skeleton (e.g spine). Punch spine to see if there is any tenderness.

17
Q

How do you Mx localised prostate cancer? Consider factors of age, Gleason score, size of tumour & life expectancy.

A

10: imaging for mets.

> 70yo
- low grade + life exp 10: debatable treatment. Prostectomy, Radiotherapy +/- ADT etc.

No chemotherapy used in localised prostate cancer

18
Q

How do you Mx metastatic prostate cancer?

A
  1. ADT (Androgen deprivation therapy) - lowering Testosterone to the level of castrated person to reduce size of prostate. ADT can be surgical (bilateral orchidectomy) or medical (GnRH analogues either agonist or antagonists). GnRH agonist need androgen receptor blockers due to the initial flare up.
    SE: feminisation, hot flushes, osteoporosis
  2. Castration resistant (ineffective ADT) prostate cancer -> chemotherapy
19
Q

Who do you screen for prostate cancer?

A

> 50 + no FMHx
40 + FMHx

Annually with PSA & DRE

20
Q

Screening guideline for colon cancer

A

FOBT (fecal occult blood test): >50 every 5 years for free. Start from 45 if colon cancer FMHx

Colonoscopy every 3 years only if +FMHx. No regular colonoscopy for no FMHx but only after a positive FOBT.

21
Q

Which area of prostate is affected in BPH? C.f. prostate cancer?

A

Transition zone

C.f. Peripheral zone: prostate cancer

Renal (11 decks)

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