Prostate Disease Flashcards
BPH:
- what does it stand for?
- What enlarges, the inner or peripheral zone?
Prostate cancer:
- Where does it spread to via lymphatics?
- Where does it spread via the blood?
- What enlarges, the inner or peripheral zone?
Benign prostatic hyperplasia
Inner zone enlargement ====== Seminal vesicles Bladder Rectum
Bone
Symptoms of prostatic enlargement:
Irritative (storage) bladder symptoms:
- Why do they get frequency and nocturia?
- Why do they get incontinence?
- Why do they get urgency?
- What other symptom do they have?
Obstructive (voiding) bladder symptoms:
- What symptoms will patients complain about? - 7
ALL THE SYMPTOMS ABOVE ARE CALLED LOWER URINARY TRACT SYMPTOMS (LUTS)
Because the prostate is enlarged, additional pressure is put on the urethra – the tube through which urine flows from the bladder and out of the body – and as a result, urine is retained in the bladder.
The incontinence can be related to overactive bladder, one of the changes in bladder function caused by BPH.
An enlarged prostate can press against the urethra and block the flow of urine, which irritates the bladder wall. As a result, the bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.
Dysuria
==== Reduced stream (size and force) Hesitancy Interruption Terminal dribbling Retention Overflow incontinence - the involuntary release of urine—due to a weak bladder muscle or to blockage—when the bladder becomes overly full, even though the person feels no urge to urinate. Bladder pain - it is too full
Symptoms suggesting cancer as opposed to BPH:
What may be found in the urine?
What may be found in semen?
Where may they feel pain?
They may experience tenesmus due to spread to bowels. What is it?
Where may they experience pain due to ureteric obstruction?
What are 2 presentations of metastases?
Haematuria - due to bladder irritation
Haemospermia
Suprapubic and perineal pain
A continual or recurrent inclination to evacuate the bowels, caused by a disorder of the rectum or other illness.
Loin pain
Bone pain and spinal cord compression
Digital rectal exam:
How does BPH feel? - 3
Is the sulcus felt?
How does prostate cancer feel? - 2
Smooth
Palpable
Rubbery prostate
Hard
Irregular
Investigations:
Screening for PCa:
- DRE and PSA are done.
- What is PSA?
- What needs to be excluded before a PSA.
- If above is present, how long do you need to postpone PSA?
Why are the following tests done:
- FBC
- U&E
- LFT
What may be done to quantify the problem?
1 month - may just be ruled out and PSA done anyway
Prostate
A UTI can also cause PSA to rise. However, your doctor can quickly rule out this condition with a simple urine test.
Anaemia
Renal impairment
Patient voiding diary
Investigating the urinary function:
What can be done to look at post-void residual?
What imaging should be done to look for hydronephrosis if there is a large post-void residual volume present or there is renal impairment?
What can be done to measure the bladder and voiding pressure?
A bladder scan/USS
Kidney USS
=====
Urine flow test
Urodynamic studies
Diagnosis of prostate cancer:
What imaging is used to diagnose it?
How is a biopsy done?
Multiparametric MRI - lookup
Transrectal US
Management of obstructive symptoms:
Why should caffeine be avoided?
Why should alcohol be avoided?
What is double voiding and why is it done?
It can increase bladder activity and result in exacerbated symptoms, including higher urgency and frequency of urination, as well as increased incontinence. Reducing or eliminating caffeine intake or switching to decaffeinated varieties can decrease symptoms.
Alcohol can increase the acidity of your urine and irritate the lining of your bladder. You may find it helpful to reduce the amount of alcohol you drink if you have regular UTIs or experience urge incontinence.
Double voiding is a technique that may assist the bladder to empty more effectively when urine is left in the bladder. It involves passing urine more than once each time that you go to the toilet.
Management - BPH - Medical:
Alpha-blockers:
- Give an example - T
- MOA
- SE
5-alpha reductase inhibitors:
- Give an example - F
- MOA
- SE
- How long does it take to work
Tamsulosin
Relax smooth muscle, therefore reducing symptoms
As anticholinergics: Drowsiness Depression Dizziness Low BP Dry mouth ==== Finasteride
Reduces testosterone, therefore, reduces prostate size
Reduced libido
Long term retention risk
3-6 months
Management - BPH - Surgical:
TURP is done. What does it stand for?
TULIP can also done. What does it stand for?
There are other options as well.
What may happen to the urethra?
Retrograde ejaculation is a complication. What is it?
Transurethral resection of the prostate
Transurethral laser-induced prostatectomy
Urethral strictures
Retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. Although you still reach sexual climax, you might ejaculate very little or no semen. This is sometimes called a dry orgasm.
Management - Prostate Cancer:
What can be done if they are unsuitable for Rx or asymptomatic?
What is done for mets?
What score can be used to grade the cancer and therefore determine the prognosis of prostate cancer?
Watchful waiting - annual PSA in primary care and managing urinary symptoms
Androgen deprivation therapy
Gleason Score
