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Renal/Urology > Prostate Problems > Flashcards

Prostate Problems Flashcards

1
Q

What are the clinical features of BPH?

A

LUTS –> both voiding and storage symptoms
Less commonly:
- haematuria
- haematospermia

On digital rectal exam (DRE):
- firm, smooth, symmetrical prostate

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2
Q

What is the International Prostate Symptom Score?

A

Questionnaire completed by every patient presenting with likely prostate symptoms
Validated screening tool to evaluate + quantify LUTS

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3
Q

What investigations should be done for suspected BPH?

A 
Urinary frequency + volume chart
Urinalysis
Post-void bladder scan (chronic retention)
Depending on DRE findings --> PSA
USS or renal tract
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4
Q

What are you looking for on USS in suspected BPH?

A

Volume of prostate (>30ml deemed enlarged)

Look for urinary retention or hydronephrosis

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5
Q

What are the management options for BPH?

A 
If asymptomatic --> reassure, no treatment required
Medication review
Lifestyle advice
Medical management
Surgical management
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6
Q

What are the medical management options for BPH?

A

Initial trial of alpha-blocker –> Tamsulosin

If unsuccessful –> 5 alpha-reductase inhibitor e.g. Finasteride

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7
Q

How quickly do alpha blockers work and what are the side effects?

A 
Provide symptomatic benefit within a few days
Side effects:
- postural hypotension
- retrograde ejaculation
- Floppy Iris Syndrome
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8
Q

How quickly does finasteride work?

A

Can take up to 6 months to see symptomatic benefit

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9
Q

When would surgical management be considered for BPH?

A

Refractory to medical management

Complications e.g. high pressure retention

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10
Q

Which surgical procedure is most commonly used for BPH?

A

Transurethral resection of the prostate (TURP)

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11
Q

What are the complications of TURP?

A

Haemorrhage
Sexual dysfunction
Retrograde ejaculation
Urethral stricture

TURP syndrome

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12
Q

What is TURP syndrome?

A

Rare but life threatening complication of TURP

  • -> significant fluid overload + hyponatraemia
  • confusion, nausea, agitation or visual changes
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13
Q

What is the main complication of BPH?

A

High pressure urinary retention –> post renal kidney injury

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14
Q

What is the main type of prostate cancer and where does it occur?

A

Adenocarcinoma (acinar type)

Usually arises in the peripheral zone of the prostate

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15
Q

What are the symptoms associated with prostate cancer?

A 
Localised disease --> LUTS
Advanced localised disease:
- haematuria
- dysuria
- incontinence
- haematospermia
- suprapubic or loin pain
- rectal tenesmus
Metastatic disease:
- bone pain
- lethargy
- anorexia
- weight loss
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16
Q

What might be felt on DRE in prostate cancer?

A

Asymmetry
Nodularity
Fixed, irregular mass

17
Q

What might cause PSA to be artificially raised?

A 
BPH
Prostatitis
Vigorous exercise
Ejaculation
Recent DRE
18
Q

How is prostate cancer diagnosed?

A

Biopsies of prostatic tissue, two possible methods:

  • transperineal (template) biopsy
  • transrectal US-guided (TRUS) biopsy
19
Q

What are the advantages/disadvantages of transperineal biopsy?

A

Done as a day case under GA
Better access to anterior prostate
Lower risk of infection

20
Q

What are the advantages/disdvantages of TRUS biopsy?

A

Done under local anaesthetic

1-2% risk of sepsis

21
Q

How is a prostate biopsy graded?

A

Gleason Grading System (based on histological appearance)

  • assigned score according to differentiation
  • sum of most common growth pattern + second most common growth pattern e.g. 3 + 3
22
Q

Which modes of imaging are used in prostate cancer?

A

Multi-parametric MRI can be used to aid in the diagnosis

Staging:

  • CT abdo pelvis
  • bone scan
23
Q

How are prostate cancer risk stratified in order to guide treatment?

A

Combination of:

  • PSA
  • Gleason score
  • Clinical stage of tumour
24
Q

What are the management options for prostate cancer?

A 
Watchful waiting
Active surveillance
Surgical management
Radiotherapy
Chemotherapy + anti-androgen therapy
25
Q

Which patients would be suitable for watchful waiting in the management of prostate cancer?

A

Older patient with lower life expectancy

26
Q

Who would would suitable for active surveillance of prostate cancer and what does it involve?

A 
Low risk disease
Monitoring:
- 3 monthly PSA
- 6 monthly-yearly DRE
- re-biopsy at 1-3 yearly intervals 
(intervene at appropriate time)
27
Q

What is the surgical management of prostate cancer?

A

Radical prostatectomy

- removal of prostate gland, seminal vesicles, surrounding tissue +/- pelvic lymph nodes

28
Q

What are the side effects of prostatectomy?

A

Erectile dysfunction (60-90%)
Strep incontinence
Bladder neck stenosis

29
Q

When is radiotherapy used in the management of prostate cancer?

A

Alternative form of curative intervention for localised prostate cancer
- external beam RT or brachytherapy

30
Q

When is chemotherapy + anti-androgen therapy indicated for treatment of prostate cancer?

A

Metastatic disease

31
Q

What causes acute bacterial prostatitis?

A

Usually ascending urethral infection

  • E. coli most common, other enteric organisms
  • STIs are a rarer cause
32
Q

What are the risk factors for prostatitis?

A

Indwelling catheters
Phimosis or urethral stricture
Recent surgery e.g. cystoscopy or transrectal prostate biopsy
Immunocompromised

33
Q

What are the symptoms of acute prostatitis?

A

LUTS
Systemic infection e.g. pyrexia
Perineal or suprapubic pain
Urethral discharge

34
Q

What might be found on examination of a patient with prostatitis?

A

DRE: very tender + boggy prostate

Inguinal lymphadenopathy

35
Q

Which investigations should be done for prostatitis?

A

Urine culture –> will guide antibiotics
STI screen + routine bloods

If failed response to antibiotics:
- transrectal prostatic US or CT to rule out abscess

36
Q

What is the management for prostatitis?

A

Prolonged antibiotic therapy
- usually quinolone as good penetration into prostate
Analgesia - paracetamol + NSAIDs

Renal/Urology (13 decks)

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