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Priority 1 > Urology > Flashcards

Urology Flashcards

1
Q

What is PSA?

What are normal PSA levels?

A

Enzyme produced by the prostate to liquify semen

Normal levels vary by age:
50s - 3
60s - 4
70s - 5
80s - 6
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2
Q

What does raised PSA indicate?

A

Marker for prostate cancer

Also raised in BPH

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3
Q

Other causes of raised PSA

A

BMI <25
Black Africans
Taller men
Recent ejaculation (avoid for 24h prior to measurement)
Recent rectal examination (usually insignificant)
Prostatitis
UTI (PSA levels may not return to baseline for some months after a UTI)
Granulomatous inflammation of prostate
Vigorous exercise in the past 48hrs

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4
Q

Prostate cancer epidemiology

A

1/3 men develop prostate cancer

Causes problems in 1/10

Lifetime risk of dying is 2-3/100

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5
Q

Histology of prostate cancer

A

Adenocarcinomas arise from epithelial cells lining the acini/ducts of prostate gland in peripheral zone of the prostate

Prostatic intraepithelial neoplasia:
Carcinoma in situ
Pre-cancerous and non-invasive
Progression common but not inevitable

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6
Q

Presentation of prostate cancer

A

Latent prostate cancer:
Asymptomatic
Slow-growing

Symptomatic prostate cancer:
Symptoms usually related to metastatic disease
Pelvic/back pain 
Pathological fractures
Anaemia from bone mets
LUTS
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7
Q

Risk factors for prostate cancer

A 
Age
Ethnicity (Afro-Caribbean)
Family history
Lynch syndrome
BRCA mutations
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8
Q

Investigations for prostate cancer

A

PSA, DRE, MRU, bone scan for metastasis

TRUS:
Transrectal US-guided biopsy of prostate

Prophylactic antibiotics:
Ciprofloxacin

Saturation/template/trans-perineal biopsy

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9
Q

Classification of prostate cancer

A

Gleason 1-6

Tumour given 2x scores (3-5):
Pattern of predominant grade
Pattern of highest grade area

3-5 - Pattern 1 is benign, pattern 2 can’t be diagnosed on biopsy as need more tissue than is typically taken
6 - Indolent, good prognosis
7 - Intermediate prognosis
8 - Aggressive, worse prognosis

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10
Q

Treatment of prostate cancer

A

Depends on grade and stage

Low risk (Gleason 6, stage T1/2):
Active surveillance
Defer treatment to maximise QoL

Gleason 3+3=6:
Only small proportion of 12 core biopsies contain cancer
Investigate at regular intervals e.g. 3 monthly review & PSA
Yearly biopsy

Locally advanced (Gleason 7-10, stage T2/3):
Radical prostatectomy
Radical radiotherapy external beam or brachytherapy

Advanced/metastatic:
Androgen deprivation therapy - LHRH agonists/antagonists or castration, abiaterone

Chemotherapy

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11
Q

Define benign prostatic hypertrophy

A

Increased number of cells (both glandular and stromal)

Not increase in size of cells

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12
Q

Signs and symptoms of benign prostatic hypertrophy

A

LUTs
Acute urinary retention
Renal dysfunction

Storage:
Frequency, urgency, UTI, renal dysfunction

Voiding:
Slow stream, splitting or spraying, intermittency, hesitancy, straining, terminal dribbling, post-micturition dribble, feeling of incomplete emptying

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13
Q

Complications of benign prostatic hypertrophy

A 
Intractable UTIs
Haematuria
UTI
Stones
Retention
Overflow incontinence
Obstructive renal failure
Hydronephrosis
Renal insufficiency/failure
Acidosis
Progressive bladder outflow obstruction
Detrusor muscle hypertrophy
Decompensation and failure
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14
Q

Investigations in benign prostatic hypertrophy

A 
History
Exam
DRE
Urinalysis
Bloods (creatinine)
PSA
Voiding diary
TRUS + biopsy
USS
CT KUB
Cystoscopy to exclude bladder cancer
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15
Q

Management of benign prostatic hypertrophy

A

Lifestyle:
Avoid caffeine, alcohol, relax when voiding, bladder training

Drugs:
Alpha-blockers, 5a-reductase, anti-cholinergics

Surgery:
Transurethral resection of prostate (TURP), HOLEP (new laser technique), transurethral incision of prostate, retropubic prostatectomy, transurethral laser induced prostatectomy (TULIP)

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16
Q

Haematuria causes

A

Painless:
Malignant

Painful:
Infection, stones, trauma, autoimmune and SLE

UUT:
RCC, stone in kidney, ureter, trauma

LUT:
Bladder cancer, BPH, infection

17
Q

Benign causes of haematuria

A 
Polycystic kidney
GN intrinsic renal disease (IgA nephropathy characteristic)
Infarct (at any point)
Stone (at any point)
Trauma (at any point)
Infection (at any point)
BPH
Prostatitis
Exercise
18
Q

Malignant causes of haematuria

A 
Renal tumours
Renal cell carcinoma
Wilms
Transitional cell carcinoma (at any point)
Papillary tumour
Prostate cancer
19
Q

Risk factors for renal cancer

A

Smoking
Raised BMI
Phenacetin

20
Q

Risk factors for bladder cancer

A 
Smoking
Industrial chemicals
Dye and rubber industry
Chronic inflammation
SCC
21
Q

Clinical assessment of haematuria

A 
History
Exam
Urine dip
MSU
MC&S

Bloods:
Creatinine, U&E, FBC, clotting, LFTs, Ca, PSA

Imaging:
X-ray, USS urogram
Flexi-cytoscopy +/- biopsy

22
Q

Types of haematuria

A

Visible/macroscopic (seen by naked eye)

Non-visible/microscopic (confirmed by urine dip or urine microscopy)

Priority 1 (17 decks)

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