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urinary > Session 11b Prostate > Flashcards

Session 11b Prostate Flashcards

1
Q

Epidemiology of prostate cancer

A

Commonest cancer in men

2nd commonest cause of death from cancer in men

1/8 men diagnosed in their lifetime

Rare in men under 50

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2
Q

Risk factors for prostate cancer

A

Increased age
FH (BRACA2 gene mutation)
Ethnicity- black>white>asian

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3
Q

Label

A
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4
Q

Prostate cancer lesions are commonly found in the

A

Periphery of posterior part of prostate

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5
Q

Prostate cancer lesions are more commonly found in the

A

Periphery of the posterior part

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6
Q

BPH usually found

A

Central

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7
Q

Presentation of prostate cancer

A

Symptoms of UTI, prostatism, metastatic disease in bone (spine) causing bone pain

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8
Q

Increasingly, carcinoma of prostate is found following

A

Investigation of elevated prostate-specific antigen (PSA) in otherwise asymptomatic men

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9
Q

Differential diagnoses:

65 y/o, hesitancy, nocturia, weight loss, lower back pain

A

BPH
Prostate cancer

Prostatitis
Urethral stricture
Multiple myeloma

Neurological: CVA, Parkinson’s, spinal cord compression

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10
Q

questions to identity BPH or prostatic cancer

A

Family history

hormone use- increased testosterone

Haematuria

Bone pains elsewhere

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11
Q

Examination for BPH or prostate cancer

A

Digital rectal examination

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12
Q

DRE of prostate cancer

A

Enlarged prostate, hard and irregular, obliteration of median sulcus

(should be smooth and plum sized, feel 2 different lobes)

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13
Q

DRE in BPH

A

A lot larger and maybe firmer

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14
Q

Causes of a raised PSA

A

Prostate cancer
Infection
Inflammation
Large prostate
Urinary retention

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15
Q

PSA comes back as 35, what does this mean

A

Normal range is less than 40 for a 60-69 year old

More than 80% chance of prostate cancer as so high

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16
Q

Doing DRE can cause

A

Raised PSA

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17
Q

What else can cause elevated PSA

A

UTI
Inflammation
Large prostate BPH
Urinary retention

18
Q

Presentation of prostate cancer

A

Urinary symptoms
Bone pain
Raised PSA,biopsy

Opportunistic finding from DRE
Incidental finding at transurethral resection of prostate

19
Q

Grading of prostate cancer

A

Gleason classification grades 1-5

TNM system

20
Q

Diagnosis of prostate cancer

A

DRE
Ultrasound
Increased PSA?
Biopsy

Radiographs and bone scans- osteoslcerotic lesions on radiographs and increased isotope uptake on both scans are seen if there is metastatic spread

21
Q

Patients in advanced prostate cancer stages can develop

A

Sclerotic bone legion- hot spots on bone scan

22
Q

Treatment for localised prostate cancer

A

Surgery, hormone therapy, radiotherapy

Surveillance

23
Q

Treatment of T1/T2 prostate cancer

A

Radical surgical resection maybe curative, TURP may be required

24
Q

Treatment of advanced prostate cancer

A

Hormonal manipulation is beneficial since testosterone promotes tumour growth (testosterone, dihydrotestosterone)

Surgical castration, medical castration (LNRH or GnRH agonist)

Palliative care

25
Q

Prognosis for prostate cancer

A

5 year survival for T1 = 75-90%

5 year survival falls to 30-45% if local of metastatic spread

26
Q

Side effects of castration

A

Hot flushes
Impotence
Thinning of bones
Diminished muscle mass
Increase in breast size
Weight gain
Mood changes

27
Q

features of Polycystic kidney disease

A

8-10% of CKD

Most common inherited nephropathy

28
Q

Presentation of Polycystic kidney disease

A

30-40 years of age with hypertension, acute loin pain, haematuria or bilateral palpable kidneys

29
Q

Pathology of Polycystic kidney disease

A

Cysts develop anywhere in kidney, compress surrounding parenchyma and impair renal function

Tubule cannot properly drain into CD

30
Q

Autosomal dominant and recessive Polycystic kidneys

A

Dominant: 1/500-1000
Recessive: 1/20000-40000

31
Q

Cysts are seen in kidneys and

A

Liver/ovaries

32
Q

Macroscopic findings Polycystic kidney disease

A

Large with yellow fluid-filled cysts replacing the parenchyma

Haemorrhage into cysts can occur

33
Q

Microscopic findings Polycystic kidney disease

A

Cysts lined with cuboidal epithelium

34
Q

USS or CT scan in Polycystic kidney disease

A

Bilateral enlarged kidneys with multiple cysts

35
Q

What is the most likely cause of pain and macroscopic haematuria

A

Adult Polycystic kidney disease

Cysts can begin to form in childhood but not clinically evident until adulthood

Cysts can fill with blood following trauma, resulting in severe abdominal pain and macroscopic haematuria

Cysts can become infected

36
Q

Further aspects of history to explore with APKD

A

Can cause hypertension and CKD, cysts in other organs, inherited (family member dying of berry aneurysm/brain haemorrhage, kidney problems etc)

Associated with valvular heart disease, diverticular disease, berry aneurism. Any history of stroke/cerebral haemorrhage should be sought

37
Q

Outcomes in APKD

A

Morbidity and mortality result of hypertension, e.g. MI and cerebrovascular disease

Condition also leads to progressive CKD

Treatment involves controlling BP

Dialysis and renal transplant needed in end stage renal failure develops

38
Q

Immediate management of APKD

A

Pain control- clots in the renal collecting system causes renal colic

IV fluids to increase urine output, attempt to wash clot out

39
Q

Information given to APKD

A

Possibility of recurrent episodes of macroscopic haematuria, given advice on management at home with simple analgesia and oral hydration

Advise to avoid contact sports in which abdominal trauma may occur (Rugby, boxing)

40
Q

What issues need to be addressed in follow up of APKD

A

Hypertensive, ECG changes consistent with LVH

treatment of bp recommended for adults with BP >130/80, ACEI preferred, can preserve renal function in patients with APKD

41
Q

Is genetic screening useful for PKD

A

Genetic screening not useful unless large number of family members with disease

Screen on annual basis for elevated BP or urine dipstick abnormalities

Late teens: ultrasound, absence of cysts at this stage would make disease unlikely

Repeated when >30 years, still no cysts = APKD virtually excluded

urinary (20 decks)

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