Urology Flashcards
Hospital treatment for pyelonephritis
ciprofloxacin
(oral is as good as IV for penetration into kidney)
If not working would then consider IV gentamicin
invex for high psa
mri prostate
prostate biopsy
bone scan
what is the imaging of choice for prostate
MRI
can you use nitrofurantoin for pyelonephritis
no - does not penetrate kidney’s well
management of prostate cancer: locally advanced and high grade
androgen therapy
chemotherapy
what genes are linked to prostate cancer
Hereditary prostate cancer 1 = HPC-1
BRCA 1
BRCA-2
When asking family hx in suspected prostate cancer what other cancers should you consider asking about
Breast cancer
BRCA 1 and 2 linked
what part of the prostate are most cancers found in
peripheral zone (75%)can feel this on prostate exam
in what part of the prostate is most BPH found
transitional zone - cant feel this from rectum but prostate may feel enlarged
what type of cancer is prostate cancer
adenocarcinoma
how does prostate cancer spread
Through capsule, into lymph nodes and to bones
Occasionally spread to organs but more common to lymph nodes and bones
how is prostate cancer diagnosed
DRE - digital rectal exam PSA If these abnormal - pt goes on to have prostate biopsy In 40s <2.5 50s: <3 60s: <4 70s: <5
list some other causes of raised PSA
UTI
BPH (age)
Instrumentation of urinary tract (catheter or cytoscope)
Retention
It is a protease produced by prostatic epithelium - prevents coagulation of seminal fluid
DRE can slightly raise PSA but only v small amount
Arguments for and against screening for prostate cancer
PSA not specific enough for screening
Morbidity with biopsies
Over diagnosis - some cancers wont go on to cause any harm
Over treatment
Anxiety that can come from a raised PSA but no cause found
how would a tumour feel on DRE
Asymmetry
Nodule
Craggy mass (hard, irregular?)
NB. Most cancers found on DRE will be locally advanced (60%) - 50% of positive DRE are prostate cancer
Investigations for prostate cancer
MRI prostate - best practice pre biopsy
Transrectal ultrasound and prostate biopsy
What are the risks of prostate biopsy
Infection (1-2% sepsis) Bleeding (semen, urine, stool) Discomfort Acute retention False negative
What are the risks of prostate biopsy
Infection (1-2% sepsis) Bleeding (semen, urine, stool) Discomfort Acute retention False negative (still possible to miss some cancers in prostate even on biospy - MRI should help prevent this)
What is the scoring system for prostate cancer
Gleason score (1-5)
Two most common scores are added together
Dont really see gleasons 1-2, mainly see 3-5 as these are when patients are symptomatic
Now graded (1-5)
How is a gleasons score calculated
A total score is calculated based on how cells look under a microscope, with the first half of the score based on the dominant, or most common cell morphology (scored 1—5), and the second half based on the non-dominant cell pattern with the highest grade (scored 1—5). These two numbers are then combined to produce a total score for the cancer.
Describe the staging of prostate cancer
T1 - impalpable but localised (not picked up on DRE, would be picked up by PSA and biopsy)
T2 - palpable but localised (picked up on DRE)
T3 - locally advanced eg into seminal vesicle, lymph nodes
T4 - advanced into other organs
what is active surveillance vs watchful waiting
active surveillance - deferred radical treatment for pts with a low grade cancer (waiting for right time to treat)
watchful waiting - deferred androgen deprivation therapy for pts not eligible for radical treatment (waiting to see if need any non-radical treatment)
What is the management of localised prostate cancer
active surveillance radical prostatectomy (removal of prostate and seminal vesicle) external beam radiotherapy (neo-adjuvancts used to shrink prostate before hand) brachytherapy (radioactive seeds into prostate - one off procedure - ultrasound guided transperineal implantation of radioactive seeds)
what do seminal vesicles do
add sugar (fructose) to semen for sperm