Prostate Disease Flashcards
What is the pathology of BPH?
Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate. Inner (transitional) zone enlarges in contrast to peripheral layer expansion seen in prostate carcinoma.
What are the symptoms of BPH?
Lower urinary tract symptoms (LUTS) = nocturia, frequency, urgency, post-micturition dribbling, poor stream/flow, hesitancy, overflow incontinence, haematuria, bladder stones, UTI
How is BPH initially investigated? (2)
Assess severity of symptoms, DRE
What tests and imaging are carried out in BPH?
MSU; U&E; ultrasound, PSA (prior to PR exam), transrectal US ± fine needle aspiration biopsy
How is BPH managed?
Lifestyle - Avoid caffeine, alcohol (to urgency/nocturia). Relax when voiding. Void twice in a row to aid emptying. Control urgency by practising distraction methods (eg breathing exercises). Train the bladder by ‘holding on’ to increase time between voiding.
What medications can be used in BPH?
Tamsulosin 400mcg/d (alpha blocker)
Finasteride 5mg/d PO (5alpha-reductase inhibitor)
What is are surgical interventions used in BPH?
transurethral resection of the prostate (TURP), Transurethral incision of the prostate (TUIP), retropubic prostatectomy
What are the signs and symptoms of prostate cancer?
Asymptomatic or nocturia, hesitancy, poor stream, terminal dribbling, or obstruction. Decreased Weight ± bone pain suggests mets.
DRE exam - hard, iregular prostate
How is prostate cancer diagnosed?
Increased PSA, transrectal US and biospy, bone scan, CT/MRI
How is prostate cancer staged?
Using an MRI
What is the gleason score?
Gleason grades (1-5) are decided by analysing histology from two separate areas of tumour specimen, and adding them to get the total Gleason score for the tumour, from 2 to 10. Scores 8–10 suggest an aggressive tumour; 5–7: intermediate; 2–4: indolent
What are the management options for low-risk patients?
‘active surveillance’ with PSA tests every 3 months for the first year. Can remove his prostate fully using a Da Vinci surgical robot or refer for radiotherapy
How is prostate cancer treated?
1) Radical prostatetcomy
2) radical radiotherapy ± hormonal therapy
3) Hormone therapy - in elderly/high risk
Active surveillane - >70 yrs and low risk
Metastatic disease - hormonal drugs
What are the prognostic factors in prostate cancer?
Pre-treatment PSA level, tumour stage (TNM), tumour grade (gleason score)
How long should you wait to do PSA after ejaculation or vigorous exercise?
48 hours
How long should you wait to do a PSA after a DRE?
1 week
What is the best initial management for a 70 year old man who presents with a 6 month history of poor urinary flow and increased nocturnal urinary frequency and who has an IPSS score of 12 and a quality of life score of 4? He has a small, benign feeling prostate, a PSA of 3.5 ng/ml normal U+E and a clinically empty bladder
Tamsulosin (alpha-adrenergic blocker)
What is the scoring system used to asses prostate symptoms?
International Prostate Symptom Score (IPSS)
What is the management options for high-risk patients?
radical prostatectomy or radical radiotherapy
