Prostate Disease Flashcards
List 4 risk factors for prostate cancer
Age
Race : black
Family hx
Genetics
What is the most common type of prostate cancer
Adenocarcinoma
Where does prostate cancer mostly originate and how does it spread
Peripheral zone
Spreads by local invasion through prostate capsule
Haematogenous spread
Lymphatic spread
List some of the most common sites of metastasis of prostate cancer
Bone
Pelvic lymph nodes
Others: liver, lungs
Outline the clinical presentation of prostate cancer
Haematuria
LUTS
Constipation
Perineal pain
Metastatic: bone pain, anaemia, renal failure
Outline the screening criteria for prostate cancer
-Shouldn’t be done in pt with life expectancy <10years
-Pt between 55-69 can be offered screening if they are appropriately counselled about risk of over diagnosis and over treatment Serum PSA and Rectal exam
-Early screening if family hx of prostate cancer
-Serum PSA and Digital Rectal exam done (sensitivity high but low specificity-can be elevated by many things)
List the benign causes of elevated PSA (no cancerous causes) (7/11)
BPH
Acute prostatitis
Prostatic infarction
Perineal trauma
Subclinical inflammation
Prostate biopsy
Cystoscope
TURP
Urinary retention
Ejaculation
DRE
How would you make the diagnosis of prostate cancer
Exam findings
-hard nodular prostate on exam
-PSA elevated (not during urinary retention or UTI, no absolute PSA considered normal, PSA>4ng/ml)
Prostatic biopsy
-transrectal or transperineal
-US guided
-MRI fusion
Discuss management for prostate cancer
(Depends on staging )
Localised:
a) Medical
Expectant- active surveillance, radical tx of progress
-you gift pt
-delay definitive to avoid side effects of tx
b) Surgery
Radical Prostatectomy (curative tx)
-open, robotic or laparoscopic
Radiotherapy (not surgical but definitive tx)
-external beam
-low dose brachytherapy
Metastatic/ locally advanced
-Hormonal manipulation
(Consider multimodal)
Medical: LHRH analogues, oestrogens, antiandrogens
Surgical: Bilateral orchidectomy (remember we are manipulating the hormones)
Metastatic-castrate resistant
-best supportive care
-Pain management (the ladder)
-painful bone mets - Radiation
-Obstructive LUTS - Channel TURP
-Intractable haematuria - Radiation prostate
-new hormonal drugs
-radium 223
-Sipaleucel T
Tabulate the differences between BPH and prostate cancer (5/8)
- Zone
BPH arises from Transitional zone vs Ca from peripheral zone - DRE
Enlarged, smooth and nodular vs Nodular and hard - Symptoms
LUTS eg nocturia, frequency etc vs often asymptomatic, bone pain or obstructive symptoms may be present - Diagnosis
Sx, DRE and urinalysis vs PSA, DRE, Prostate biopsy - Non cancer cells vs cancer cells
- Does not spread vs spreads to other areas
- Not life threatning vs can be life threatening
- Range of treatment to relive sx vs tx depends on stage of cancer and your health
What causes obstruction of flow in BPH
o Static factors: Physical increase in tissue of enlarged prostate
o Dynamic factors: Smooth muscle tension due to alpha adrenergic action
List the sx of BPH/ clinical presentation of BPH
Symptoms manifest as lower urinary tract symptoms
o Obstructive/voiding symptoms
▪ Incomplete emptying
▪ Intermittency
▪ Poor stream
▪ Straining
-post micturition dribbling
o Irritative/storage symptoms
▪ Urgency
▪ Frequency
▪ Nocturia
What examination findings would you expect to find in a pt with BPH
General:
-Pyrexial (may suggest UTI)
-Tachycardia - sepsis & symptomatic anaemia
Abdo
-palpable percussable bladder suggesting retention
Genitalia
-Epydidymitis
PR
-prostate size,
-exclude ca
What investigations would you do to confirm BPH
Side-room investigations
➢ Dipstix
o Exclude UTI and haematuria
➢ Flowrate
o Measures urine flow over time
o “Normal”
▪ Bell-shaped curve
▪ Flowrate >15ml/second
o Flow <10ml/second = LOW
▪ May be obstruction or atonic detrusor
Special investigations
➢ Creatinine
➢ PSA only if clinically indicated
➢ Ultrasound KUB
o Optional
o Do in patients with suspected chronic retention, a large post-micturition residual
volume, and possible hydronephrosis
Discuss management of BPH
o Expectant
▪ Reserved for patients with mild symptoms not requiring intervention
o Medical
▪ Alpha-blockers
▪ 5-alpha reductase inhibitors
o Surgery
▪ Transurethral resection of the prostate (TURP)
▪ Open
