Prostate and Bladder Disease

Question 1

What are the zones of the prostate?

Answer 1

Anterior fibromuscular zone.

Preprostatic sphincter.

Transitional zone.

Central zone.

Peripheral zone.

Question 2

What is PSA?

Answer 2

Prostate-specific antigen = anything that causes disease in the prostate, cancerous or not, will cause PSA to rise.

Question 3

What are the classical symptoms of benign prostate disease?

Answer 3

Difficulty to urinate.

Retention.

Question 4

What are the classical symptoms of prostate cancer?

Answer 4

Asymptomatic in the majority of patients because it arises from the peripheral zone.

It is detected by PSA tests and abnormal digital rectal exam findings (felt as a hardened prostate, asymmetry, nodule or fixed craggy mass).

Lower urinary tract symptoms.

• Haematuria/haematospermia.*
• Bone pain, anorexia, weight loss.*

Question 5

What are the indications for a trans-rectal USS guided prostate biopsy?

Answer 5

Men with an abnormal digital rectal exam, an elevated PSA.

Previous biopsies showing prostate intraepithelial neoplasia (PIN) or atypical small acinar proliferation (ASAP).

Previous normal biopsies but rising PSA trends.

Question 6

What is the apex of a prostate?

Answer 6

Inferior portion of the prostate, continuous with the striated sphincter.

Question 7

What is the epithelium of the prostatic urethra?

Answer 7

Transitional epithelium.

Question 8

Where is the verumontanum?

Answer 8

The part of the prostatic urethra in which the ejaculatory ducts drain into.

Just distal to urethral angulation.

Ejaculatory ducts (union of seminal vesicles and each vas deferens) drain to each side of the prostatic urethra.

Question 9

What is the transitional zone of the prostate?

Answer 9

Surrounds the prostatic urethra proximal to the verumontanum.

• In young men, accounts for only 10% of prostatic glandular tissue.*
• Only ~20% of prostate cancer* arise from the transitional zone.
• Gives rise to benign prostatic hyperplasia..*

Question 10

What is the central zone of the prostate?

Answer 10

Cone shaped region that surrounds the ejaculatory ducts.

• 25% of glandular tissue in young adults.*
• Only 1-5% of prostate cancer from this region.*

Question 11

What conditions elevate the PSA?

Answer 11

Benign prostatic hyperplasia.

Retention.

Catheterisation.

Digital rectal exam.

Question 12

What is the peripheral zone of the prostate?

Answer 12

Posteriolateral prostate.

• Majority of prostatic glandular tissue.*
• Origin of up to 70% of prostate adenocarcinoma.*

Question 13

How many biopsies are taken from the prostate in a trans-rectal USS guided prostate biopsy?

Answer 13

10 in total (5 from each lobe).

Question 14

What type of cancer is the majority of prostate cancers?

Answer 14

>95% are multifocal adenocarcinomas.

The pattern of tumour growth tends to start with local extension through the prostatic capsule, to the urethra, bladder base and seminal vesicles and with perineural invasion along autonomic nerves.

Question 15

Which sites are the common sites for metastatic prostate depotis?

Answer 15

Pelvic lymph nodes.

Skeleton (sclerotic lesions).

Question 16

What is the Gleason’s scoring system?

Answer 16

Gives a score based on the architectural appearance of the prostate glands rather than cytological features.

Score is out of 10 (8-10 = high risk disease.).

Question 17

Give a broad classification of prostate cancer staging?

Answer 17

Organ-confined disease = T1-2 N0 M0.

Locally advanced disease = T3-4 N0 M0.

Metastatic disease = N+ M+.

Question 18

What are the management options for organ-confined prostatic disease?

Answer 18

Watchful waiting.

Deferred treatment.

Symptom-guided treatment.

Active surveillance/monitoring.

Radical surgery.

Radical radiotherapy.

Question 19

What are the management options for locally advanced prostatic disease?

Answer 19

Radiotherapy. with neoadjuvant hormonal therapy.

Watchful waiting.

Hormonal therapy.

Question 20

What are the management options for metastatic prostatic disease?

Answer 20

Androgen deprivation therapy with LHRH analogues, anti-androgens, bilateral subcapsular orchidectomy or maximal androgen blockade.

Diethylstilbesterol/steroids.

Cytotoxic chemotherapy.

Question 21

What are the types of urinary bladder cancer?

Answer 21

Non-muscle invasive.

Muscle-invasive.

Question 22

How does urinary bladder cancer tend to present?

Answer 22

Haematuria.

Question 23

What are the main types of urinary bladder cancers?

Answer 23

90% transitional cell tumours.

9% squamous cell tumours.

~1% adenocarcinoma, sarcoma, undifferentiated, benign mesodermal.

Question 24

How are transitional cell carcinomas classified?

Answer 24

Papillary type (80%; 1/2 are infiltrative malignancies).

Non-papillary type (20%; all are considered to be malignant).

Question 25

How can a uroepithelial tumour be imaged for diagnosis?

Answer 25

Excretory urogram.

Sonography.

Retrograde pyelogram.

CT.

Angiography.