Prostate and Testicular Disease

Question 1

what is BPH characterised by?

Answer 1

fibromuscular and glandular hyperplasia

Question 2

what does BPH predominantly affect?

Answer 2

transition zones

Question 3

what symptoms to ask about LUTS? (6)

Answer 3

hesitancy
terminal dribbling
incomplete emptying
frequency
nocturne
urgency +\- incontinence

Question 4

physical examination? (4)

Answer 4

palpable bladder?
urethral meatal stricture?
digital rectal examination
urinalysis - blood? UTI?

Question 5

investigations? (5)

Answer 5

MSSU
flow rate study
post-void bladder residual USS
bloods - PSA, urea and creatinine
flexible cystoscopy if haematuria

Question 6

treatment of BPH?

Answer 6

watch and wait
medical - alpha blockers & 5a reductase inhibitors
surgery - TURP

Question 7

Alpha blockers?

Answer 7

main treatment for BPH

antagonise and cause smooth muscle relaxation

Question 8

types of alpha blockers and example?

Answer 8

non-selective = phenoxybenzamine
selective short-acting = prazosin
selective long-acting = alfuzosin
highly selective - tamulosin

Question 9

5a-reductase inhibitor?

Answer 9

converts testosterone to dihydrotestosterone

reduces prostate size

Question 10

two 5a-reductase drugs?

Answer 10

Finasteride

Dutasteride

Question 11

best treatment for BPH?

Answer 11

combination therapy of 5ARIs and alpha blockers in order to reduce risk of progression to BPE

Question 12

what is the gold standard surgery?

Answer 12

Transurethral resection of prostate (TURP)

Question 13

complications in TURP?

Answer 13

retrograde ejaculation

stress urinary incontinence

Question 14

what is the blood supply to the prostate? Ln?

Answer 14

internal iliac artery

LN are pelvic

Question 15

what are the FH genes involved in prostate cancer? (2)

Answer 15

HPC1

BRCA1/2

Question 16

diagnostic triad in prostate cancer?

Answer 16

PSA + digital rectal examination + TRUS guided biopsies

Question 17

what is PSA? job?

Answer 17

Kallikrein serine protease

liquifies semen

Question 18

normal PSA serum range?

Answer 18

0-4ug/ml

increases with age

Question 19

PSA chances of cancer? half life?

Answer 19

2.5-4 = 25%
4-10 = 40%
>10 = 70%

2.2days
important to recheck within 3 weeks

Question 20

causes of PSA elevation?

Answer 20

UTI
chronic prostatitis
instrumentation
recent procedure
BPH
prostate cancer

Question 21

what is the grading used in prostate cancer?

Answer 21

Gleason Grading of Prostate Cancer

Question 22

what is the scoring?

Answer 22

3 to 5

well to poorly differentiated

two scores that are summated min 6 max 10

Question 23

what is the new grading system?

Answer 23

ISUP grade group

Question 24

treatment for prostate cancer?

Answer 24

radiotherapy - external or brachytherapy
radical prostatectomy
hormone

Question 25

hormone therapy?

Answer 25

lowers the body’s testosterone that is driving the cancer
surgical castration
chemical castration - LHRH analogues

Question 26

testicular cancer presentation?

Answer 26

painless lump

Question 27

what is a risk factor in testicular cancer?

Answer 27

maldescent

Question 28

tumour markers in testicular cancer?

Answer 28

AFP alfa-fetoprotein (teratoma)
BHCG
LDH lactate dehydrogenase

Question 29

investigation in testicular cancer?

Answer 29

testicular US and car
MSSU
tumour markers

Question 30

treatment in testicular cancer?

Answer 30

radical orchidectomy is essential

consider bilateral biopsy

Question 31

most common testicular cancer pathology?

Answer 31

germ cell tumour

- seminomatous and non-seminomatous

Question 32

types on non-GCT?

Answer 32

leydig
sertoli
lymphoma (rare)

Question 33

what affects who?

Answer 33

seminoma = 30-40yrs

non-seminoma 20-30yrs