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Renal > Prostate Pathology > Flashcards

Prostate Pathology Flashcards

1
Q

What age group is benign prostate disease more common?

A

>50 incidence increases with age

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2
Q

How does benign prostatic hyperplasia present?

A

Hesitancy

Urgency/urge incontinence

Frequency

Intermittency

Straining to void/poor stream

Terminal dribbling

Incomplete emptying

Enlarged prostate on DRE

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3
Q

What investigations are used in benign prostate disease diagnosis?

A

Urine dipstick/urinalysis

  • Exclude infection

PSA

  • Exclude prostate cancer

U&E

TRUS-Guided Prostate Biopsy

  • If raised PSA or abnormal digital rectal examination
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4
Q

What is the conservative management of benign prostate disease?

A

Watchful waiting

Avoid caffeinated, sugary drinks, evening fluids

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5
Q

What is the medical management of benign prostate disease?

A

Alpha Blockers

5 Alpha Reductase Inhibitors

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6
Q

What is the mechanism of action of alpha blockers?

A

Decrease smooth muscle tone/relax muscle

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7
Q

Name examples of alpha blockers

A

Tamsulosin 400mcg once daily

Alfuzosin

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8
Q

Give adverse effects of alpha blockers

A

Dizziness

Postural hypotension

Dry mouth

Depression

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9
Q

What is the mechanism of action of 5 Alpha Reductase Inhibitors?

A

Converts testosterone to dihydrotestosterone and reduces size of prostate

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10
Q

Name examples of 5 Alpha Reductase Inhibitors

A

Finasteride

Dutasteride

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11
Q

Give adverse effects of 5 Alpha Reductase Inhibitors

A

Erectile dysfunction

Reduced libido

Ejaculation problems

Gynaecomastia

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12
Q

How long do 5 Alpha Reductase Inhibitors take to work?

A

Up to 6 months

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13
Q

Give risk factors for developing TURP syndrome

A

Surgical time > 1 hr

Height of bag > 70cm

Resected > 60g

Large blood loss

Perforation

Large amount of fluid used

Poorly controlled CHF

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14
Q

Describe TURP

A

Involves accessing the prostate through the urethra and ‘shaving’ off prostate tissue from inside using diathermy, in order to create a wider space for urine to flow through, thereby improving symptoms

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15
Q

Give complications of TURP

A

FIRES

Failure to revolve symptoms

Incontinence

Infection

Retrograde ejaculation

Erectile dysfunction

(Urethral) strictures

TURP syndrome

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16
Q

Name complications of benign prostate disease

A

Bladder outflow obstruction

Acute urinary retention

Overflow incontinence

Acute renal failure

Bladder stones

Recurrent UTI

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17
Q

What is TURP syndrome?

A

Rare and life-threatening complication of TURP caused by irrigation with large volumes of glycine, which is systemically absorbed when prostatic venous sinuses are opened up during prostate resection.

This results in hyponatremia, and when glycine is broken down by the liver into ammonia, hyper-ammonia and visual disturbances.

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18
Q

What is the surgical managemet of benign prostate disease?

A

Transurethral resection of the prostate (TURP)

Transurethral electrovaporisation of the prostate (TUVP)

Holmium laser enucleation of the prostate (HoLEP)

Open prostatectomy via abdominal or perineal incision

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19
Q

What is the International Prostate Symptom Score Sheet?

A

Classifies symptoms out of 35

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20
Q

What score is mild prostate symptoms?

A

0-7

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21
Q

What score is moderate prostate symptoms?

A

8-19

22
Q

What score is severe prostate symptoms?

A

>20

23
Q

Describe category 1 prostatitis

A

Acute infection of the prostate

24
Q

Describe category 2 prostatitis

A

Chronic infection of the prostate

25
Q

Describe category 3 prostatitis

A

Chronic pelvic pain syndrome, without infection but with or without inflammation

26
Q

Describe category 4 prostatitis

A

Asymptomatic inflammatory prostatitis after TURP/prostate biopsy

27
Q

What pathogens can cause prostatitis?

A

E-coli

Pseudomonas

Klebsiella

28
Q

What pathogen is the most common cause of prostatitis?

A

E coli

29
Q

Give risk factors for prostatitis

A

Recent UTI

Urogenital instrumentation

Intermittent bladder catheterisation

Recent prostate biopsy

30
Q

How does prostatitis present?

A

Pelvic, urethral, perineal or rectal pain

Frequency

Urgency

Sepsis and urinary retention if category 1

Fever and rigors

Tender, boggy prostate on examination

31
Q

How is prostatitis managed?

A

14 day course of quinolone, such as ciprofloxacin

32
Q

How common is prostate cancer?

A

Most common cancer in adult males in the UK and is the second most common cause of death due to cancer in men after lung cancer

33
Q

What are the risk factors for prostate cancer?

A

Increasing age

Afro-Caribbean ethnicity

Obesity

FH

Diet

Steroids

34
Q

What is the most common histological type of prostate cancer?

A

95% adenocarcinoma

35
Q

How does prostate cancer present?

A

Mainly asymptomatic

Weak stream

Hesitancy

Sensation of incomplete emptying

Frequency

Urgency/urge incontinence

UTI

Haematuria and Haemospermia

Perineal and Suprapubic pain

Impotence

Incontinence

Loin pain

Bone pain

Weight loss

Paraplegia

Lymph node enlargement

Lymphedema

36
Q

What investigations are used in prostate cancer diagnosis?

A

Opportunistic Prostate Specific Antigen Testing (PSA)

Digital rectal examination

  • A cancerous prostate may feel firm/hard, asymmetrical, craggy or irregular with loss of the central sulcus

Trans-rectal US (TRUS) and biopsy

Multiparametric MRI

37
Q

What is a normal PSA level?

A

0-4.0ug/ml

38
Q

What can cause a rise in PSA other than prostate cancer?

A

Prostatitis

UTI

BPH

Vigorous DRE

Ejaculation

Exercise

39
Q

What is the gold standard investigation for prostate cancer?

A

Multiparametric MRI

40
Q

What staging is used for prostate cancer?

A

Gleason staging

41
Q

How is localised prostate cancer managed?

A

Active surveillance, monitor PSA and treat if rises

42
Q

How is localised advanced prostate cancer managed?

A

Radiotherapy/Brachytherapy

Radical Prostatectomy

Hormonal therapy

43
Q

How is metastatic prostate cancer managed?

A

Hormonal therapy

44
Q

Give adverse effects of radiotherapy for prostate cancer

A

Radiation proctitis

Rectal, bladder and colon malignancy

45
Q

Give adverse effects of radical prostatectomy

A

Erectile dysfunction

Incontinence

46
Q

Give adverse effects of hormonal therapy

A

Hot flushes

Sexual dysfunction

Gynaecomastia

Fatigue

Osteoporosis

47
Q

What is used in hormonal therapy?

A

GnRH agonists

  • Goserelin

GnRH antagonists

  • Degarelix

Testosterone antagonists

  • Flutamide
  • Bicalutamide
48
Q

What time frame should psa not be done within?

A

6 weeks of a prostate biopsy

4 weeks following a proven urinary infection/prostatitis

1 week of digital rectal examination

48 hours of vigorous exercise

48 hours of ejaculation

49
Q

What should be prescribed with GnRH agnosist in prostate cancer management?

A

Anti-androgen treatment such as cyproterone acetate or flutamide should be co-prescribed 3 day before starting gonadorelin analogues due to the risk of initial symptom/tumour flare

50
Q

What is the most common site of bone metastases?

A

in descending order

Spine

Pelvis

Ribs

Skull

Long bones

Renal (10 decks)

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