prostate

Question 1

BPH is

Answer 1

benign prostatic hyperplasia
very common affecting men over 50 years
hyperplasia of stromal and epithelial cells of prostate

Question 2

BPH presents with

Answer 2

There are typical lower urinary tract symptoms (LUTS) that occur with prostate pathology:

Hesitancy
Weak flow
Urgency
Frequency
Intermittency
Straining to pass urine
Terminal dribbling
Incomplete emptying
Nocturia

Question 3

BPH investigation

Answer 3

rectal
penis
abdominal
urinary frequency volume chart
MSSU
urine disptick
prostate specific antigen- if raised then TRUS guided biopsy
renal tract US

Question 4

BPH management

Answer 4

Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms
5-alpha reductase inhibitors (e.g., finasteride) gradually reduce the size of the prostate, reduces testosterone
transurethral resection of prostate TURP- gold standard
open prostatectomy

watch and wait asymptomatic

Question 5

BPH management

Answer 5

Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms
5-alpha reductase inhibitors (e.g., finasteride) gradually reduce the size of the prostate
transurethral resection of prostate TURP
open prostatectomy

Question 6

zones of prostate

Answer 6

transition
central
peripheral
anterior fibromuscular stroma

Question 7

BPH affects what zone

Answer 7

transition

Question 8

short term catheters should not be left in for more than

Answer 8

4 weeks

Question 9

long term catheters should not be left in for more than

Answer 9

12 weeks

Question 10

bladder outflow obstruction management

Answer 10

cystolithiolapaxy and TURP
or nothing or catheterisation

Question 11

acute urinary retention treatment

Answer 11

catheterisation and alpha blocker
remove catheter in 2 days
2nd time- TURP
treat underlying cause

Question 12

acute urinary retention signs

Answer 12

painful and percussible bladder, inability to void. can lead to haematuria

Question 13

chronic urinary retention signs

Answer 13

painless, palpable and percussible after voiding. can lead to haematuria

Question 14

chronic urinary retention managment

Answer 14

if symptomatic- catheterisation, IV fluids, CISC or TURP, long term catheter

Question 15

prostate cancer epidemiology

Answer 15

commonest in men, 3rd commonest cause of cancer death

Question 16

RFs for prostate cancer

Answer 16

genetics, obesity and diet, age, tall, black african or caribbean, anabolic steroids

Question 17

diagnosis of prostate cancer

Answer 17

usually asymptomatic and opportunistic

if locally invasive- haemturia, incontinence, loin pain, renal failure, haemospermia, rectal symptoms

systemic symptoms eg bone pain, lethargy etc

Question 18

PSA ranges for age

Answer 18

less than 50: 2.5 is upper limit
50-60: 3.5 “
60-70: 4.5 “
70 plus: 6.5 upper limit

cancer has persistent rise, should check at least 3 weeks

Question 19

investigations for prostate cancer

Answer 19

PSA
rectal DRE
MRI multiparametric (first line for suespcted localised cancer)
biopsy (2nd line for establishing)

Question 20

grading for cancer

Answer 20

gleason sum score 3-5 (5 is worst)
or ISUP 1-5
TNM staging

Question 21

localised treatment for prostate cancer

Answer 21

watch and wait
radiotherapy
radical prostatectomy
ablative
hormone therapy (testosterone)

Question 22

what zone is mainly affected by cancer

Answer 22

peripheral zone

Question 23

what is prostate specific antigen

Answer 23

glycoprotein that is secreted in the semen, with a small amount entering the blood. Its enzymatic activity helps thin the thick semen into a liquid consistency after ejaculation. It is specific to the prostate, meaning it is not produced anywhere else in the body. A raised level can be an indicator of prostate cancer.

Question 24

prostatitis signs and symptoms

Answer 24

fever
malaise
dysuria
urinary frequency
pelvic pain
swelling of acutely inflamed prostate

Question 25

prostatitis treatment

Answer 25

ciprofloxacin 500mg twice daily
ofloxacin 200mg twice daily second line