*Prostate d/o

Question 1

C/F of BPH

Answer 1

Urge incontinence
↑Frequency
Nocturia
Obstructed flow
Retention of urine after voiding

Question 2

Per-rectal findings in BPH

Answer 2

Per-rectal findings:
1. Smooth surface, no nodules
2. Symmetrical enlargement
3. Medial sulcus palpable
4. Non-tender

Question 3

Mx, Drugs to shrink prostate size

Answer 3

1. Alpha blockers - prazosin, tamsulosin
2. Alpha blocker + Dutesteride(↓testosterone)

TURP - Trans urethral resection of prostate

Question 4

Prostate cancer findings in per-rectal exam

Answer 4

1. Hard mass
2. Irregular borders
3. Medial sulcus non palpable
4. Asymmetrical enlargement

Question 5

Investigations for prostate d/o

Answer 5

Initial: PSA (normal - 3ng/ml)

Also:
Urine MCS
USG - kidney, ureter, bladder, prostate

PSA not done for screening
Prostate CA screening in fam h/o - PSA every year

Question 6

Investigation flow for prostate cancer

Answer 6

1. PSA - >4ng/ml
2. MRI - prostate - suspicious nodule
3. TRUS - biopsy (staging)
4. Gleason score (low 1-10 high)
   8-10 score: highly aggressive

Question 7

Long term complication of prostate sx?

Answer 7

Retrograde ejaculation

Question 7

Mx of prostate cancer

Answer 7

If life expectancy <10yrs (AUS - 84 yrs expectancy)
Recent update: <7yrs
Observe
EBRT - external beam radiotherapy (no mets)

If life expectancy >10yrs
Radical prostatectomy - confined to prostate
Radiotherapy - locally advanced
Hormone therapy - metastatic prostate cancer (bone)
●Also called androgen deprivation therapy
●LHRH analogues
●Radiotherapy (EBRT) if bony metastasis
●B/L orchidectomy rarely

Question 8

Raised PSA after prostatectomy (cancer). Mx?

Answer 8

Metastasis

Full body PET scan should be done