Urology

Question 1

What are the common symptoms of prostate pathology?

Answer 1

LUTS

hesitancy, frequency, weak flow, nocturia, incomplete emptying, straining, terminal dribbling, urgency

Question 2

How useful is PSA in assessing prostate pathology?

Answer 2

Unreliable
75% false positives (falsely investigated)
15% false negatives (falsely reassuring)

Question 3

What causes a raised PSA?

Answer 3

Prostate cancer
BPH
Prostatitis 
UTI
Vigorous exercise (particularly cycling)
Recent ejaculation

Question 4

How is BPH investigated?

Answer 4

PR exam
Abdo exam (palpable bladder)
Urine chart (input/output for 3 days)
Urine dipstick (infection, haematuria, other pathology)
PSA (for prostate cancer, patient choice)

Question 5

How is BPH managed?

Answer 5

Medical: tamsulosin + finasteride

(tamsulosin = alpha-blocker, immediate symptom relief from smooth muscle relaxation
side effect = postural hypotension)
(finasteride = reduce size of prostate, longer term therapy - <6months for action)

Surgical = TURP (transurethral resection of prostate) - remove part of prostate from inside urethra

Question 6

What are the 2 types of prostatitis?

Answer 6

Acute bacterial prostatitis
Chronic prostatitis (infective/non-infective)

Question 7

How does prostatitis present?

Answer 7

Pelvic pain
LUTS
Sexual dysfunction 
Painful bowel movements 
Tender + enlarged prostate on exam 

Acute = systemic signs of infection (fever, fatigue, myalgia, nausea, sepsis)

Question 8

How is prostatitis diagnosed?

Answer 8

PR exam (enlarged + tender)
Abdo exam (distended bladder)
Urine dipstick + culture
STI screen

Question 9

How is acute vs chronic prostatitis managed?

Answer 9

Acute = Abx (28 days ofloxacin, ciprofloxacin or trimethoprim)
Analgesia/laxatives

Chronic: 
Tamsulosin (symptom relief), 
Abx if within 6 months of symptom onset
Laxatives/analgesia
Psychological therapy (if psychosocial symptoms)

Question 10

What are the symptoms of prostate cancer?

Answer 10

LUTS (freq, hesitation, weak flow, nocturia)
Haematuria
Erectile dysfunction
Weight loss/bone pain/cauda equina (if advanced/mets)

Question 11

How is prostate cancer diagnosed?

Answer 11

PSA

PR exam (craggy, hard, asymmetrical, irregular, loss of central sulcus)

Multiparametric MRI (1st line - reported on Likert scale)

Prostate biopsy (transurethral or transperineal)

Isotope bone scan (for bony mets)

Question 12

What is the Gleason score and what does it indicate?

Answer 12

Grading system for severity or prostate cancer, used to guide treatment
Based upon histology from biopsies (2 numbers added together)

<6 = low risk
7 = intermediate risk
>8 = high risk

Question 13

How is prostate cancer managed?

Answer 13

Surveillance / watchful waiting (if early stage)

External beam radiotherapy (proctitis side effect)

Brachytherapy (radioactive seeds inserted into prostate, continuous targeted radiotherapy to prostate)

Hormone therapy (androgen receptor blocker - Bicalutamide)

Surgery (radical prostatectomy with curative intent)