Disease of the Prostate Flashcards by Becky Dunlop

What are the different McNeal zones of the prostate?

Transitional zone
Peripheral zone
Central zone
Anterior fibromuscular stroma

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Which zone of the prostate is most likely to cause obstruction of urethra?

Transition zone

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Which zone of the prostate is likely to undergo hypertrophy?

Transition zone

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Which zone is likely to be felt whilst performing PR examination?

Peripheral zone

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What does BPE stand for?

Benign Prostatic enlargement

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What does BPH stand for?

Benign prostatic hyperplasia (pathological finding)

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What does BPO stand for?

Benign prostatic obstruction (clinical entity)

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What does BOO stand for?

Bladder outflow obstruction

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What does LUTS stand for?

Lower urinary tract symptoms

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What does the Hald diagram demonstrate?

BOO
BPE
LUTS
These 3 can coexist or occur independently

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Where does hyperplasia of the prostate usually occur?

Transition zone

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Will BPH result in BOO?

Not always

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Why is BPE so common in men over 60 yrs?

The prostate gland continues to grow throughout life

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What are some obstructive LUTS?

Hesitancy
Poor stream
Terminal driblling
Incomplete emptying

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What are some storage or irritative LUTS?

Frequency
Nocturia
Urgency +/- urge incontinence

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What are some of the physical findings on examination of someone with BPE?

Palpable bladder

PR examination - enlarged prostate

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What is phimosis?

Inability to pull foreskin back, becomes tight

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What is para-phimosis?

When the foreskin is retracted but does not move back (emergency)

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When feeling for a prostate what are you assessing?

Size
Texture
Consistency
Tenderness

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What investigations might you do if suspected BPE?

MSSU 
Flow rate study 
Post-void bladder residual USS
Bloods : PSA &amp; urea, creatinine
Flexible cystoscopy

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What are the 2 types of BPO?

Uncomplicated

Complicated

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What are the treatment options for uncomplicated BPO?

Watchful waiting
Alpha blockers
5 alpha reductase inhibitors (combo)

TURP
Prostectomy

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What is the main medical treatment for BPO?

Alpha blockers

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How do alpha blockers mediate action?

Cause smooth muscle relaxation of internal urethral sphincter & prostate

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What alpha blocker is highly selective?

Tamsulosin

What might be one of the side effects of an alpha blocker? Why?

``` Retrograde ejaculation (relaxation of internal urethra sphincter) ```

What is the action of 5 reductase inhibitors?

Prevents the conversion of testosterone to dihydrotestosterone

What effect does 5 redcoats inhibitors have on prostate?

Reduces testosterone therefore size of prostate

What does TURP stand for?

Transurethral resection of prostate

What is the gold standard surgical treatment for BPO?

TURP

What are some of the side effects of TURP?

Bleeding Infection Retrograde ejaculation

What are some of the complications of BOO?

``` Acute/ chronic urinary retention Urinary incontinence (overflow) UTI Bladder stones Renal failure ```

What are some options for complicated cases of BOO?

Catheterisation | Intermittent self-catheterisaition

What is the commonest cause of cancer in men?

Prostate cancer

What blood test would you perform to test for prostate hypertrophy?

PSA

What are the main risk factors of prostate cancer?

Age Race (AAs increased risk) Family history

Which zone of the prostate is usually affected with cancer?

Peripheral zone

Which zone does the urethra extend through?

Transition zone

What symptoms usually present with prostate cancer?

Asymptomatic

80% of prostate cancers are said to be ____ therefore have a better prognosis.

Localised

How are the majority of prostate cancers diagnosed?

Through opportunistic PSA testing

What is the diagnostic triad of prostate cancer?

PSA Digital rectal examination TRUS-guided prostate biopsy

If a prostate cancer is locally invasive, what are some of the symptoms which might be experienced?

``` Haematuria Incontinence Impotence Haemospermia Loin pain or auria ```

Where is the most common area of metastatic spread in prostate cancer?

Bone

Screening for prostate cancer was proved non beneficial because it lead to ______.

Over-treatment | Over-diagnosis

Which areas of the population do you target with ad-hoc PSA testing?

Older males (urinary problems?)

What is PSA?

Kallikrein serine protease produced by glands of prostate but can leak into serum

What is the normal range for PSA?

0-0.4ug/ml

Why do levels of PSA increase with age?

Prostate gland continues to grow throughout life

Other than prostate cancer, what else can cause increased PSA?

``` UTI PR examination Catheterisation Ejaculation BPH ```

If the level of PSA >10, what is the likelihood of cancer?

70%

What are the different grades of prostate cancer?

Score 3-5

What is the Gleason SUM score composed of?

Most common histological cell type + the second most common cell type

What is the highest/ lowest Gleason score?

6 | 10

What investigations may be useful to identify prostate staging?

``` Digital rectal examination PSA CT scan MRI Transrectal US guided biopsy ```

What are some of the main treatments used for localised prostate cancer?

Watchful waiting Radiotherapy (external beam or brachytherapy) Radical prostatectomy

What are some types of hormonal therapy used for metastatic prostate cancer?

Bilateral orchidectomy Chemical castration (LHRH Antagonist) Oestrogen

What are the different stages of prostate cancer/

``` Localised Locally advanced (T3-4, N0) Metastatic (T, N1 or M1) ```

What is the usual presenting sign of testicular cancer?

Painless lump

What are the lesser common presenting signs of testicular cancer?

Inflammed, tender swelling | History of trauma

In what population is testicular cancer most common?

Young men (3rd decade)

What are the main risk factors for testicular cancer?

Testicular maldescent Infertility Atrophic testis Previous cancer

What are the tumour markers associated with testicular cancer which can be tested for in the blood?

AFP (alpha-fetoprotein) bHCG (Human chorionic gonadotrophin) LDH (lactate dehydrogenase)

What are the differential diagnoses associated with testicular cancer?

Epididymal cyst Missed testicular torsion Infection (epididymo-orchitis)

What initial investigations may be carried out to test for testicular cancer?

MSSU Testicular USS & CXR Tumour markers (blood test)

What is the treatment for testicular cancer?

Radical orchidectomy

Do you ever biopsy in testicular cancer?

No (maybe contralateral side for high risk tumours)

In testicular cancer, where is the main lymphatic spread observed?

Para-aortic lymph nodes

Where is the incision made when performing radical orchidectomy?

Groin (inguinal) region

What is the most common pathology of testicular cancers?

Germ cell tumour (95%) Seminomatous GCT Non-seminomatous GCT

What types of Non-GCT of testicular cancer can be found?

Leydig Sertoli Lymphoma

Which pathological type of GCT testicular cancer affects those 30-40yrs?

Seminoma

Which pathological type of GCT testicular cancer affects those 20-30yrs

Non-seminomatous

If a tumour is low grade, what will the cells be like?

Well-differntiated

Why is tumour grading useful?

Tells you about the aggressiveness of a tumour

If a tumour is high grade, what will the cells be like?

Poorly differentiated

What does tumour staging refer to?

The spread of the tumour

What are the different types of tumour spread which can occur?

``` Local spread Regional spread (lymph) Distant spread (metastatic) ```

How many different stages are present in testicular cancer?

What can be administered in combination with orchidectomy?

Adjuvant radiotherapy or in metastatic disease = chemotherapy

Disease of the Prostate Flashcards

(80 cards)