The Prostate

Question 1

BPH Epidemiology

Answer 1

Men
>60
Present in all men >49
20% reared treatment

Question 2

BPH pathology

Answer 2

Fluctuating androgen and oestrogen
Hyperplasia in central zone
-> decreased lumen

Question 3

BPH clinical features

Answer 3

Frequency 
Nocturia
Hesitancy
Poor streaming 
Post void dribbling
Acute retention 
Haematuria
UTI
Chronic retention

Question 4

BPH investigations

Answer 4

Urine dip and culture
U and E’s
Micturition flow test

Question 5

BPH management

Answer 5

Watchful waiting if manageable
A blockers-> helpful in smaller glands
5a reductase inhibitions -> helpful in large glands

Surgery
TURP -> endoscope and diathermy/laser
>100g ->prostatectomy

Question 6

BPH surgery complications

Answer 6

Bleeding
Absorption of irrigation fluid-> hypernatremia
Failure to void
Infection 
Incontinence
Erectile dysfunction
Retrograde ejaculation 
-> 79% satisfied

Question 7

Prostate cancer epidemiology

Answer 7

7% of male cancer
Increased malignant change with age
80% of 80y

Question 8

Prostate cancer pathology

Answer 8

Adenocarcinoma
Arises in the true prostate glands in periphery
Invades locally before disturbing urethra
Mostly dependent on testosterone for growth

Invasive-> invade and metastasise

Latent-> small foci, well differentiated, remain confined to prostate

Occult-> present as metastasis

Mets-> bone, nodes, bladder

Question 9

Prostate cancer Gleason grading

Answer 9

1) well differentiated and well defined
2) minimal invasion
3) clearly infiltrator but still distinctive
4) no longer single glands
5) no differentiation
- -> advanced

Most malignant + most common

Question 10

Prostate cancer clinical features

Answer 10

Symptoms of lower urinary tract obstruction
Less commonly symptoms of metastatic spread
Incidentally finding
PSA screening >10 50% cancer
Enlarged on DRE

Question 11

Prostate cancer investigations

Answer 11

PSA
U and E's
Urine dip and culture
Urine flow studies and post micturition bladder scan
Transracial USS biopsy 
ALP
MRI and bone scan

Question 12

Prostate cancer managment active surveillance

Answer 12

Moderate to well differentiated
Small and low presenting PSA
>65
Asymptomatic

Question 13

Prostate cancer endocrine therapy

Answer 13

90% of testosterone is produced in the testes, 10% adrenal
Androgen suppression:
-locally advanced and mets
-LNRH analogues -> pituitary down regulation
-subcut 1-3m
-reduces testosterone to castrate levels

Androgen ablation:
-bilateral subcapsular orchidectomy

Chemotherapy if fails

Question 14

Prostate cancer managment radiotherapy

Answer 14

Control bony met pain
Tumour confined to prostate
Brachytherapy-> radioactive seeds in prostate

Question 15

Prostate cancer managment surgery

Answer 15

Transurethral resection -> acute obstruction/retention

Radical prostatectomy

• disease local to prostate
• 1% mortality
• incontinence
• erectile dysfunction
• strictures

Question 16

Prostate cancer prognosis

Answer 16

Confined to capsule with radical prostatectomy-> 55% survive 10y
Mets at presentation 25% at 5y