Prostate Flashcards
What part of the prostate if affected in BPH vs carcinoma?
Inner transitional zone in BPH enlarges
Peripheral zone in cancer
What are clinical features of BPH?
Nocturia Frequency Urgency Post-micturition dribble Poor stream/flow Hesitancy Overflow incontinence Haematuria Bladder stones UTI
What investigations in BPH?
MSU U&E US - large residual volume, hydronephrosis (urine filled dilation of renal pelvis due to obstruction) PSA (prior to PR exam) TRansrectal US Biopsy
What lifestyle management in BPH?
Avoid caffeine, alcohol
Relax when voiding
Void twice in a row to aid emptying
Control urgency by practising distraction methods - breathing
Train bladder by holding on to increase time between voiding
What drugs can be used in BPH?
Alpha blocker - tamsulosin - reduces smooth muscle tone in prostate and bladder.
SE: drowsiness, depression, dizziness, dry mouth, hypotension, ejaculatory failure
5alpah reductase inhibitors (finasteride) can be added or alone (reduces conversion of testosterone to more potent dihydrotestosterone)
Excreted in semen so use condoms
SE: impotence, reduced libido, reduced prostate size
What are surgical options of BPH?
Transurethral resection of prostate - XM 2U of blood
Trasnureatural incision of prostate - less destruction than TYURP, less risk to sexual function, relieves pressure on urethral
Retropubic prostatectomy if v large
What are risks of TURP?
Haematuria, haemorrhage Haemmatopsermia Hypothermia Urethral trauma Post TURP syndrome - hypothermia and hyponatraemia Infection ED Incontinence Clot retention
What advice for TURP?
Avoid driving for 2 wks after
Avoid sex for 2 weeks after
Expect to pass blood in urine for first 2 weeks
May have frequency at first
If feverish or pain or urination take sample to GP
What are associations in prostate cancer?
Where are they found
How do they spread
Family history Increased testosterone Increased age Adenocaricinoma in peripheral prostate Spread local to seminal vesicles, bladder, rectum, via lymph or haematogenously
What are symptoms of prostate cancer?
Asymptomatic Nocturia Hesitancy Poor stream Terminal dirbbling Obstruction
Weight loss and bone pain suggests mets
What does PR exam show?
Hard, irregular prostate
How is prostate cancer diagnosed and staged?
raised PSA
Trasrectal US and biopsy
Bone scan
CT/MRI
What are the prognostic factors in prostate cancer?
Pre-treatment PSA
Tumour stage TNM
Tumour grade - Gleason score
Describe the gleason grades of prostate cancer?
1-5
Analysing histology from two separate areas of tumour and adding them to get gleason score from 2 to 10
8-10 is aggressive
5-7 intermediate
What are treatment options in prostate cancer?
Radical prostatectomy if < 70 yo
Radical radiotherapy is alternative - beam or brachytherapy
Hormone therapy alone - temproalriy delays tumour progression- consider in elderly unfit patients
Active surveillance - <70 and low risk
Metastatic disease - hormonal drugs may benefit fo 1-2 yrs
