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Urology > Prostate Pathology > Flashcards

Prostate Pathology Flashcards

1
Q

what is the cause of benign prostatic hyperplasia?

A

age

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2
Q

what are the clinical features of BPPH?

A

Lower Urinary Tract Symptoms
Voiding symptoms
Storage symptoms
Post-micturition: dribbling

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3
Q

what are the examination findings of BPPH?

A
  • Benign prostate will always feel smooth on DGE + PR

* Abdo exam may show palpable bladder

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4
Q

what are lower urinary tract symptoms?

A

nocturia, frequency, urgency, post-micturition, dribbling, poor stream/flow, hesitancy, overflow incontinence, haematuria, bladder stones, UTI

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5
Q

what are obstructive voiding symptoms?

A

weak or intermittent urinary flow, straining, hesitancy, terminal dribbling and incomplete emptying

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6
Q

what are the complications of BPPH?

A

urinary tract infection, retention, obstructive uropathy, stones

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7
Q

what are the microscopic features of BPPH?

A

hyperplasia of both the connective (stromal) tissue, and of the glandular (epithelial) tissue

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8
Q

what is the pathophysiology of BPPH?

A

Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate – smooth
o Nodules particularly around prostatic urethra = bladder symptoms

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9
Q

what part of the prostate does BPPH occur in?

A

transitional zone

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10
Q

What investigations are done for BPPH diagnosis?

A
  • PR exam
  • PSA
  • Urine MC+S and dipstick
  • Bloods: U&E, LFTs
  • Transrectal US +/ biopsy
  • Also: Bladder scan, Renal Ultrasound, Cystoscopy, Urine flow analysis, Pressure Study
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11
Q

what is the management of BPPH?

A
  • Lifestyle: avoid caffeine, alcohol, large fluid intakes, avoid constipation, bladder training
  • Drugs: alpha blockers – tasulosin, alfuzosin, doxazosin
  • 5α reductase – finasteride 5mg/d PO
  • Surgery
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12
Q

what is the surgical management of BPPH?

A

o Transurethral resection of prostate (TURP)
o Transurethral incision of prostate (TUIP)
o Retropubic prostatectomy
o Transurethral laser-induced prostatectomy (TULIP)

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13
Q

what are the risk factors associated with prostate cancer?

A

old age, obesity, high fat/low fibre

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14
Q

what genetic mutations are associated with prostate cancer?

A

BRCA 1, BRCA 2

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15
Q

what is the most common kind of prostate cancer?

A

adenocarcinoma

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16
Q

what are the other types of prostate cancer?

A

transitional cell carcinoma (transitional zone), small cell prostatic cancer (neuroendocrine cells)

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17
Q

which part of the prostate does cancer normally occur?

A

peripheral zone - basal and luminal cells

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18
Q

what is the pattern of growth of prostate cancer?

A

o Pattern of growth starts with local extension through prostatic capsule (seminal vesicles, bladder, rectum, urethra)

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19
Q

what is the lymphatic spread of prostate cancer?

A

obturator nodes

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20
Q

how does prostate cancer metastasise?

A

o Hemogenic Spread – skeleton

o Perineural invasion along autonomic nerves

21
Q

what are the clinical features of prostate cancer?

A
  • Asymptomatic
  • Lower Urinary Tract Symptoms
  • Also: haematuria, haematospermia, incontinence, perineal or suprapubic pain, impotence, rectal pain and tenesmus, UTI
  • Weight loss +/- bone pain suggests mets
22
Q

what will a prostate cancer feel like in DRE?

A

asymmetrical, nodule, fixed craggy mass

23
Q

what investigations are used for prostate cancer diagnosis?

A

DRE
PSA
TRUS biopsy
Imaging - xray, bone scan, CT, MRI

24
Q

how are prostate cancers staged?

A

MRI - Gleasons scoring and TNM

25
Q

what is PSA?

A

prostatic specific antigen is a glycoprotein enzyme reduced by secretory epithelial cells and is involved in liquefaction of semen

26
Q

what are PSA levels in prostate cancer?

A

PSA serum level raised

27
Q

When else might PSA serum levels be raised?

A

prostatitis, UTI, BPH, DRE

28
Q

what is the management of prostate cancer confined to prostate?

A

o Radical prostatectomy – if <70 years
o Radical radiotherapy (+/- neoadjuvant & adjuvant hormone therapy)
o Hormone therapy
o Active surveillance if >70 and no symptoms
o Cryotherapy?

29
Q

What is the management of metastatic prostate cancer?

A

Hormonal Drugs
 LHRH agonists – goserelin
 Anti-androgen – cyproterone acetate, bicalutamide
 LNRH antagonist – degarelix
Also?:bilateral subcapsular orchidectomy, diethylstilboestrol/steroids cytotoxic cryotherapy

30
Q

what is the mechanism of action of LHRH agonists?

A

Down regulation of LHRH receptors with subsequent suppression of pituitary LH and FSH secretion + testosterone production (initially can cause raised LH and FSH)

31
Q

what are examples of LHRH agonists?

A

busarelin, goserelin, histrelin, leuprolein

32
Q

what are the side effects of LHRH?

A

loss of libido, hot flushes + sweats, weight gain, gynaecomastia, anaemia, cognitive changes, osteoporosis

33
Q

what is the mechanism of action of anti-androgens?

A

Compete with testosterone and DHT for binding sites on their receptors in prostate cell nucleus, promoting apoptosis + inhibiting CaP growth

34
Q

What are the two types of anti-androgens?

A

Steroidal, Non-Steroidal

35
Q

What are examples of steroidal anti-androgens?

A

cyproterone acetate

36
Q

What are examples of non-steroidal anti-androgens?

A

nilutamide, flutamide, bicalutamide

37
Q

what are the side effects of steroidal anti-androgens?

A

loss of libido, erectile dysfunction, gynaecomastia, CVS and hepato toxicity

38
Q

what are the side effects of non-steroidal anti-androgens?

A

gynaecomastia, breast pain, flushes, hepatotoxicity

libido maintained

39
Q

what are the types of prostatitis?

A
  • Acute Bacterial Prostatitis
  • Chronic Bacterial Prostatitis
  • Chronic Prostatitis
  • Asymptomatic Inflammatory Prostatitis
40
Q

what are the risk factors to developing prostatitis?

A

Hx of STI, Hx of UTI, Indwelling catheter, Post procedure – e.g. post prostate biopsy, age, Diabetes mellitus, Immunosuppression

41
Q

what organisms are causes of bacterial prostatitis?

A

o Gram negative organisms – such as E. coli, enterobacter, serrate, pseudomonas, proteus
o Sexually transmitted organisms – neisseria gonorrhoea, chlamydia
o Rarely – tuberculosis

42
Q

what are the non-bacterial causes of prostatitis?

A

o Increase prostatic pressure
o Pelvic floor myalgia
o Emotional causes
o Infection with unknown organism
o Immune reaction to antigen from previous infection
o Pelvic nervous system dysfunction
o Mechanical issue causing retention of prostatic fluid

43
Q

what are the clinical features of acute bacterial prostatitis?

A

UTI like, Retention, Pain

Hamatospermia, Swollen/boggy prostate on DRE, Inguinal lymphadenopathy, Urethral discharge, Systemic

44
Q

what are the clinical features of chronic bacterial prostatitis?

A

Symptoms as acute bacterial but >3months
More gradual in onset, may be non-specific
Prostate exam normal

45
Q

what are the clinical features of chronic non-bacterial prostatitis?

A

pain with or without urinary symptoms

Chronic illness with acute exacerbations

46
Q

what is the diagnostic criteria for chronic non-bacterial prostatitis?

A

Pelvic discomfort or pain >3 months duration
Negative urine and prostatic fluid culture
Leukocytes may present in prostatic fluid

47
Q

what is the management of acute bacterial prostatitis?

A

Analgesia

Antibiotics – levofloxacin, consider STI cover

48
Q

what is the management of chronic bacterial prostatitis?

A

Analgesia

Antibiotics

49
Q

what is the management of chronic non-bacterial prostatitis?

A

Analgesia
Antibiotics
Alpha Blockers
Stress management

Urology (10 decks)

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