UROLOGY- PROSTATE Flashcards
Outline the age-adjusted upper limits for PSA/
50-59 - 3 ng/ml
60-69 - 4 ng/ml
>70 - 5 ng/ml
What can raise PSA?
BPH
Prostatitis
UTI
Ejaculation, prostate stimulation, anal sex
Vigorous exercise
Urinary retention
Instrumentation of urinary tract
What supplies venous draining of the bladder?
Vesicoureterine plexus into the internal iliac vein
What type of drug is bicalutamide? What’s it used for
An androgen receptor blocker
Used to treat prostate cancer
What type of drug is goserelin? What’s it used for?
GnRH agonist - prostate cancer
Whats the function of the prostate?
Produces 20-30% of the volume of seminal fluid which nourishes and protects the sperm (its alkaline so helps sperm survive acidic vagina whilst also providing nutrients)
What phenotype is BPH most likely to affect?
Older man of Afro-American origin
How does BPH present?
Urinary frequency
Urinary urgency
Hesitancy
Dysuria
Dribbling
Incomplete bladder emptying feeling - causes Nocturia
Push/strain to overcome obstruction
What examination should you do for bpH?
Abdominal
Digital rectal examination
What investigations should be done for BPH?
Urine dipstick microscopy and culture
U&E, creatinine, FBC. LFTs
PSA
Imaging
How do you manage BPH?
If symptoms are minimal - watchful waiting
Medications - alpha 1 antagonist and 5 alpha reductase inhibitors
Surgery - TURP, open prostatectomy,
What are the complications of BPH?
Urinary retention
Recurrent UTI
Hydronephrosis and renal failure
Bladder calculi
Bladder hypertrophy
Haematuria
Whats the function of prostate specific antigen?
This enzyme participates in the dissolution of the seminal fluid coagulum and plays an important role in fertility
What are the androgens and where are they produced?
Testosterone produced by testcicles
Dihydrotestpsterone produced in prostate by 5 alpha reductase (converts testosterone to this)
Whats the main difference between testosterone and dihydrotestosterone?
Dihydrotestosterone is 10 times more potent than testosterone as it can bind to androgen receptors for longer
Why does BPH increase with age?
After the age of 30, men produce about 1% less testosterone per year
But.. 5 alpha reductase activity increases = increase in dihydrotestosterone
Normal prostate cells respond to this by living longer and multiplying
Why does BPH cause bladder hypertrophy?
Nodules tend to form in the periurethral zone of the prostate
This can compress the prostatic urethra and make it difficult for urine to pass
Urine builds up in the bladder causing it to dilate
Smooth muscle walls contract harder which eventually leads to bladder hypertrophy
Whats the pathology of BPH?
Increase in 5 alpha reductase activity with age increases dihydrotestosterone
These act on epithelial cell androgen receptors and cause inhibition of normal cell death and hyperplasia
Nodules form in transition zone of prostate, narrowing the urethral canal
What are the risk factors for BPH?
Increased age
FHx
Heart disease and diabetes
Beta blocker use
Obesity - increase intra-abdominal pressure which raises intravesicle pressure
Why don’t we screen for prostate cancer in the UK?
PSA testing only has a sensitivity of 21% and specific yet of 91%
Early detection doesn’t correlate with clinically beneficial outcome
Men with abnormal PSA will have a prostate biopsy which has complications
Overdiagnosis leads to unnecessary treatment which can be harmful
False positives cause unnecessary anxiety
Which area of the prostate do most prostate cancers arise?
Peripheral zone
How common is prostate cancer?
Commonest cancer in men
Lifetime risk of 1/6
What age is most common for prostate cancer?
75-84
How long does it take for serum PSA to reduce back to its original value after rising?
4-8 weeks