Prostate - BPH, Prostate cancer

Question 1

BPH
-risk factors
-presentation

Answer 1

Older men
Black > white > Asian

FUNWISE
-frequency
-urgency
-nocturia
-weak stream
-intermittent
-straining
-emptying incomplete

Can use International Prostate Symptoms Score (IPSS) to classify severity

Question 2

BPH
-investigations

Answer 2

DRE - differentiate between prostate cancer
Dipstick urine - rule out UTI, bladder malignancy

U&E
PSA

Bladder USS with post bladder volume - assess degree of obstruction

Question 3

BPH
-management

Answer 3

Lifestyle
-avoiding fluids before bed
-reduce alcohol, caffeine consumption
-double voiding

Medication if QOL affected
-a blocker (reduce smooth muscle tone) - tamulosin
-5aReducatse inh - finasteride (takes 6 months to work
-if severe, combine both

Surgery for severe symptoms
-TURP/TUIP

Question 4

Complications of BPH

Answer 4

Inability to empty urine properly
-UTI
-Urinary stones
-urinary retention
-AKI

Question 5

Prostate cancer
-risk factors
-presentation
-types and grading

Answer 5

Older men
Black > white > Asian
FHx - BRCA1,2
Obesity, sedentary lifestyle

FUNWISE
Hematuria
Back/perineal/testicular pain
-FIRST PRESENTATION CAN BE WITH BACK PAIN => SCLEROTIC LESIONS, PATHOLOGICAL #

Most common - adenocarcinoma
Graded with Gleason score
-2 best, 10 worst

Question 6

Prostate cancer
-2ww referral criteria

Answer 6

DRE - malignant feeling psotate
PSA - above age specific reference range

Consider if
-LUTS
-ED
-VH

Question 7

Prostate cancer
-investigations

Answer 7

DRE, PSA

Refer for MRI
-biopsy taken based on MRI findings

Question 8

Prostate cancer
-management

Answer 8

Depends on life expectancy and patient choice
-active monitoring, watchful waiting
-radical prostatectomy
-radiotherapy - external beam/brachytherapy

Hormonal therapy
GnRH agonist - gosorelin
-can attentuate tumour flare with flutamide (antiandrogen)

RT comes with increased risk of proctitis

Question 9

PSA
-what can give a high reading

Answer 9

BPH
Prostatitis, UTIs - test 1 month after UTI
Ejaculation/vigourous exercise in last 48hrs
Urinary retention