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PROSTATE Flashcards

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1
Q

McNEEL’S ZONES of PROSTATE

A
  1. Central Zone
  2. Transitional Zone
  3. Peripheral Zone
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2
Q

LOBES OF PROSTATE

A
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3
Q

BPH MOST COMMONLY INVOLVES which ZONE of PROSTATE

A

Transitional Zone

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4
Q

Primary PROSTATE CANCER usually affects which zone

🧠⚡3Ps⚡

A

Primary PROSTATE CANCER
⬇️
Posterior LOBE
⬇️
PERIPHERAL Zone affected

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5
Q

⭐ Central & TRANSITIONAL Zone contains which type of Glands

⭐ PERIPHERAL Zone contains which type of Glands

A

⭐ Central & TRANSITIONAL Zone contains which type of Glands
🎯 SHORT UNBRANCHED GLANDS

⭐ PERIPHERAL Zone contains which type of Glands
🎯 LONG BRANCHED GLANDS

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6
Q

Which ZONES are removed in TURP

A

Central
➕
Transitional
➕
Most of the PERIPHERAL zone

⭐ A Portion of PERIPHERAL ZONE is left behind

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7
Q

Why BPH patient CAN STILL DEVELOP PROSTATE CANCER even after TURP

A

⭐ A Portion of PERIPHERAL ZONE is left behind

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8
Q

FALSE CAPSULE in BPH is formed by

A

Transitional zone

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9
Q

Between TRUE PROSTATE CAPSULE & FALSE PROSTATE CAPSULE, lies

A

PROSTATIC VENOUS PLEXUS

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10
Q

Relation NERVE Bundles responsible for ERECTION with Prostate Capsule

A

Posterolateral to CAPSULE

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11
Q

NERVE Bundles responsible for ERECTION can be injured in which PROCEDURE

A

Radical PROSTATECTOMY

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12
Q

⚡⚡ MOST COMMON COMPLICATION following TURP

A

Retrograde EJACULATION

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13
Q

Cause of Retrograde EJACULATION after TURP

A

Bladder neck & sphincter damage during TURP

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14
Q

Retrograde EJACULATION
Classical FEATURE

A

No SEMEN during INTERCOURSE
➕
SEMEN comes OUT LATER in URINE

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15
Q

Types of PROSTATIC STONES

A
  1. Endogenous
    ✨ Less COMMON
  2. Exogenous
    ✨ MORE COMMON
    ✨ From KIDNEY or BLADDER
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16
Q

⚡⚡ MOST COMMON ENDOGENOUS Stone OF PROSTATE

A

Calcium PHOSPHATE

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17
Q

💊💉 MANAGEMENT of PROSTATIC STONE

A

No management required

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18
Q

Corpora AMYLACEA

A

Lamellated bodies found in PROSTATE

✨ Precursor for PROSTATIC STONES

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19
Q

⚡⚡ MOST COMMON CAUSE of ACUTE BACTERIAL PROSTATITIS

A

E. coli

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20
Q

Tender BOGGY PROSTATE is a Characteristic feature of

A

Acute PROSTATITIS

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21
Q

Prostatic massage should be avoided in ACUTE PROSTATITIS
WHY?

A

Can lead to SEPTICEMIA

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22
Q

Threads in URINE EXAMINATION seen in

A

Acute PROSTATITS
Chronic PROSTATITIS

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23
Q

Long ANTIBIOTIC THERAPY is needed for ACUTE PROSTATITIS
Why?

A

Antibiotics don’t penetrate PROSTATIC CAPSULE
⬇️
Continue for longer duration
2-3 WEEK Therapy

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24
Q

Causes of CHRONIC Prostatitis

A

Repeated episodes of ACUTE PROSTATITIS

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25
🧑🏻‍⚕️ Clinical Features of CHRONIC PROSTATITIS
1. Prostatodynia (Dull Perineal or Pelvic Pain) 2. Dysuria
26
3 TUBE TEST ✨ synonyms ✨ USED for?
✨ synonyms STANDARD MEARES & STAMEY TEST ✨ USED for? 🎯 CHRONIC PROSTATITIS
27
3 TUBE TEST Procedure
✨ 1st TEST TUBE contains: 1st VOIDED URINE: 10ml (Probably comes from URETHRA) ✨ 2nd TEST TUBE contains: MIDSTREAM SAMPLE (Probably comes from BLADDER) ⬇️ ⬇️ do PROSTATIC MASSAGE ✨ 3rd TEST TUBE contains: 1st Voided Sample POST PROSTATIC MASSAGE ⬇️ If CHRONIC PROSTATITIS ➕ ➡️ THREADS ➕
28
DURATION OF ANTIBIOTIC THERAPY IN CHRONIC PROSTATITIS 🧠⚡Double that of ACUTE⚡
4-6 weeks ✨ Ciprofloxacin ✨ Trimethoprim ✨ Doxycycline
29
STORAGE (IRRITATIVE) SYMPTOMS (LUTS) 🧠⚡FUN IN Pain⚡
1. Frequency 2. Urgency 3. Nocturia 4. Incontinence 5. Pain
30
VOIDING ( OBSTRUCTIVE) SYMPTOMS (LUTS) 🧠⚡WISE Person⚡
1. Weak stream 2. Intermittency 3. Straining 4. Emptying INCOMPLETE 5. Post-Void Dribbling
31
Storage (IRRITATIVE) Symptoms: MOST COMMONLY Seen in
NEUROGENIC BLADDER
32
Voiding (OBSTRUCTIVE) Symptoms: MOST COMMONLY Seen in
BLADDER OUTLET OBSTRUCTION
33
⚡⚡ MOST COMMON SYMPTOM OF BPH ⚡⚡ EARLIEST SYMPTOM OF BPH
⚡⚡ MOST COMMON & EARLIEST SYMPTOM OF BPH 🎯 FREQUENCY ⬆️⬆️
34
Which LUTS does not resolve following TURP
Post void dribbling
35
Post Micturial LUTS
Incomplete EMPTYING ➕ POST VOID DRIBBLING
36
Which lobe of PROSTATE affected in Adenoma? 🧠⚡MAD ⚡
Median Lobe
37
Causes of ACUTE RETENTION of URINE
1. BPH 2. Strictures in URETHRA 3. Postoperative retention of urine ✨ Hemorrhoidectomy ✨ Fistulectomy IN ♀️ 1. Hysteria 2. Retroverted Gravid Uterus 3. Urethral stenosis
38
💊💉 MANAGEMENT of ACUTE RETENTION OF URINE
Put FOLEY'S CATHETER (OR) SUPRAPUBIC CATHETER
39
Definition of CHRONIC RETENTION of Urine
≥ 250 ml of RESIDUAL URINE is present chronically
40
🧑🏻‍⚕️ Clinical Features of CHRONIC RETENTION of URINE
NO PAIN ➕ 1. Incomplete emptying of Bladder 2. Overflow INCONTINENCE 3. PALPABLE BLADDER 4. Renal Impairment
41
💊💉 MANAGEMENT of CHRONIC RETENTION
Urgent CATHETERIZATION with INTERMITTENT CLAMPING
42
Rapid Decompression in CHRONIC RETENTION can cause
HEMATURIA
43
Adequate fluid needs to given after POST-OBSTRUCTIVE DIURESIS in CHRONIC RETENTION of urine
Dehydration can occur
44
FIRM RUBBERY PROSTATE is seen in
BPH
45
HARD NODULAR PROSTATE is seen in
Cancer
46
⭐ Mucosa over PROSTATE is MOBILE in ⭐ Mucosa over PROSTATE is FIXED in
⭐ Mucosa over PROSTATE is MOBILE in 🎯 BPH ⭐ Mucosa over PROSTATE is FIXED in 🎯 CANCER
47
USG KUB is done in PROSTATIC pathology for
1. PROSTATIC Volume 2. Residual Volume 3. Presence of HYDRONEPHROSIS 4. Lymph NODE status
48
Types of FREE PSA 🧠⚡BIP⚡
1. B-PSA (nicked) ➡️ INCREASES in BENIGN Condition 2. I-PSA (Intact) ➡️ INCREASES in BENIGN condition 3. Pro-PSA ➡️ INCREASES in PROSTATIC CANCER
49
Serum PSA = 0-3 ng/ml seen in
1. Normal 2. BPH 3. PROSTATITIS
50
Serum PSA > 3-4 ng/ml seen in
1. BPH 2. CANCER 3. PROSTATITIS
51
🩺 IOC to differentiate BPH & CANCER
TRUS guided Truecut BIOPSY
52
Biopsy for PROSTATE: SAMPLES
12 cores taken ✨ Cores taken from 1. Base 2. Mid Part 3. Apex 4. Medial 5. Laterally: LEFT 5. Laterally: RIGHT
53
COMPLICATIONS of PROSTATIC BIOPSY
1. Hematuria 2. Hematospermia 3. Rectal Bleeding
54
Types of PROSTATIC BIOPSY
55
Reduction in PERCENTAGE of FREE PSA indicates
PROSTATE CANCER
56
PSA VELOCITY meaning
Change in PSA Value with TIME
57
PSA VELOCITY > 0.75 ng/ml/year indicates
PROSTATIC CANCER
58
Approach to LUTS
59
Uroflowmetry should be done only if Urine output is
> 100 ml
60
Uroflowmetry: Interpretation
< 10 ml/s: Bladder Outlet Obstruction 10-15 ml/s: Equivocal > 15 ml/s: NORMAL
61
Bladder Pressure Interpretation
> 80 cm H2O : High 60-80 cm H2O : Equivocal < 60 cm : NORMAL
62
Bladder Outlet Obstruction vs Neurogenic Bladder
✨ Bladder Outlet Obstruction 🎯 ⬆️⬆️ Bladder Pressure 🎯 ⬇️⬇️ Flow Rate ✨ Neurogenic Bladder 🎯 ⬇️⬇️ Bladder Pressure 🎯 ⬇️⬇️ Flow Rate
63
PROSTATISM SANS PROSTATE (OR) MARION'S Disease
Hypertrophy of Internal Sphincter ⬇️ Features like BPH
64
BPH Features in Young ♂️ ➕ Normal Features
Marion's disease (OR) Prostatism sans PROSTATE
65
Anatomical Changes occuring in BPH
1. Urethral Lumen ⬇️ ⬇️ 2. Prostatic Urethra lengthened ⬆️ 3. Exaggerated Posterior Curve of Urethra 4. ⬆️ Pressure in Bladder ✨ Bladder Muscle Hypertrophy ✨ Trabeculations ✨ Diverticula ➕ ✨ Hydronephrosis
66
🧑🏻‍⚕️ Clinical Features of BPH
LUTS
67
Components of BPH
⭐ STATIC 🎯 Stromal Hypertrophy DUE TO: DHT ⭐ DYNAMIC 🎯 ⬆️ Smooth Muscle Tone DUE TO: Alpha 1 Receptors
68
Why a Curved Catheter is required for BPH patient
Exaggerated Posterior Curve of Urethra
69
IPSS Score used for
PROSTATE Hypertrophy
70
IPSS
International Prostate System Score ✨ 8 questions are asked, having specific marks 0-7 : Mild BPH ➡️ Observation 8-19: Moderate BPH ➡️ Medical management 20-35: Severe BPH ➡️ Medical (OR) Surgical MANAGEMENT
71
💊💉 Medical MANAGEMENT of BPH
1. Alpha 1a Blockers ➡️ Acts on DYNAMIC COMPONENT of BPH ➡️ Rapid ONSET ✨ Tamsulosin ✨ Alfuzosin 2. 5 alpha Reductase inhibitors ➡️ Acts on STATIC Component of BPH ➡️ Slow Onset ➡️ Sustained Effect ✨ Finasteride ✨ Dutasteride
72
🤢😳SIDE EFFECTS🥴😵 of ALPHA 1A BLOCKERS
1. 1st DOSE EFFECT 2. POSTURAL HYPOTENSION
73
Indications of Surgical Intervention in BPH
1. Hydronephrosis 2. Acute (OR) Chronic Retention of Urine 3. Multiple episodes of UTI 4. Gross Hematuria 5. Diverticula (OR) Stones 2° to BPH 6. Flow rate < 10 ml/s 7. Bladder pressure > 80 cm H2O 8. Not responding to medication
74
Surgical 💊💉 MANAGEMENT of BPH 🧠⚡Minimal: TTH ⚡
1. Minimally Invasive Surgery ⭐ TURP: Transurethral Resection of PROSTATE ⭐ TULIP: Transurethral Laser Incision of PROSTATE ⭐ HOLEP: Holmium Laser Enucleation of PROSTATE 2. OPEN SURGERY: MILLIN'S APPROACH
75
MILLIN'S APPROACH is used for
Open Retropubic Approach for PROSTATE
76
Lasers used for BPH
1. Nd:YAG 2. KTPA Laser 3. Holmium Laser
77
⚡⚡ MOST COMMON LASER FOR BPH ⚡⚡ BEST LASER FOR BPH
⚡⚡ MOST COMMON LASER FOR BPH 🎯 Nd:YAG ⚡⚡ BEST LASER FOR BPH 🎯 KTPA
78
Hemostatic Lasers
1. KTPA 2. Holmium
79
Procedure of TURP
Go through Urethra with Resectoscope ⬇️ Cut off chips of PROSTATE ⬇️ Deliver them out
80
For Clear Field of Vision during TURP Surgery, what is used
Irrigating Fluids ✨ Isotonic Glycine ✨ Distilled Water ✨ 5% Dextrose ✨ NS
81
NS as irrigating fluid can be used only if
Bipolar Cautery is being used
82
⬆️ Risk of TURP Syndrome seen with which Irrigating fluids
5% Dextrose Distilled Water
83
Complications of TURP
1. Hemorrhage 2. TURP Syndrome (OR) Water Intoxication (OR) Dilutional Hyponatremia 3. Incontinence 4. Retrograde Ejaculation 5. Re-operation 6. Stricture 7. Clot retentiom
84
⚡⚡ MOST COMMON Complication of TURP during Surgery ⚡⚡ MOST COMMON Complication of TURP following Surgery
⚡⚡ MOST COMMON Complication of TURP during Surgery 🎯 Hemorrhage ⚡⚡ MOST COMMON Complication of TURP following Surgery 🎯 Retrograde Ejaculation
85
Cause of HEMORRHAGE in TURP
1. Badenoch's Artery @5o'clock & 7o'clock 2. Smaller Flock Arteries @ 10o'clock
86
Clot Retention can be prevented by
3 way Foley's
87
TURP SYNDROME
Water gets absorbed from urethra to Blood vessels, about 1 L can move in
88
🧑🏻‍⚕️ Clinical Features of TURP Syndrome
1. Altered Sensorium 2. Headache 3. Nausea & Vomitting
89
💊💉 MANAGEMENT of TURP Syndrome
⭐ Sodium < 120 mEq/L ➡️ 3% Hypertonic Saline Infusion Gradually ⭐ Sodium > 120 mEq/L ➡️ Fluid Restriction
90
Rapid Correction of Hyponatremia leads to
Central Pontine Myelinolysis / Demyelinosis
91
How much Hyponatremia should be corrected per day
8 mEq/L
92
Development of TURP depends on
1. Fluid selected for Irrigation 2. Duration of Surgery
93
⚡⚡ MOST COMMON Site of Urethral Stricture
Bladder Neck
94
LASER used for BPH patient, who is on Anticoagulant Therapy
KTPA Green Light Laser
95
PIRADS
PROSTATE Imaging Reporting And Data System
96
Risk factors for PROSTATE CANCER
1. Age 2. Testosterone ⬆️ 3. African American Males 4. Obesity 5. BRCA2 > BRCA1 6. Alcohol 7. Smoking
97
⚡⚡ MOST COMMON GENE Mutated in PROSTATE Cancer
GSTP-1 Ch 11 (Glutathione S Transferase Hypermethylation)
98
🩺 IOC for DIAGNOSIS🚦 OF PROSTATIC CANCER 🩺 IOC for SCREENING OF PROSTATIC CANCER
🩺 IOC for DIAGNOSIS🚦 OF PROSTATIC CANCER 🎯 TRUS Guided Trucut Biopsy 🩺 IOC for SCREENING OF PROSTATIC CANCER 🎯 DRE ➕ PSA
99
Screening of PROSTATE cancer begins by
Annually from 50 yrs age
100
IOC for Staging of PROSTATE CANCER
PET-CT
101
mpMRI Components
Multi parametric Prostatic MRI 1. T-stage 2. LN Status 3. Recurrance evaluation 4. Follow up
102
⚡⚡ MOST COMMON Site of Distant Spread of Prostate Cancer
Bones (Vertebral Column ➡️ Lumbar Vertebrae)
103
Type of Metastasis in PROSTATE cancer
Osteoblastic > Osteolytic
104
Why Vertebral Column spread in PROSTATE cancer
Batsons Plexus of Valveless Veins
105
Indication of BONE SCAN in PROSTATE cancer
1. PSA > 10ng/ml 2. Gleason's score ≥ 7 3. Symptomatic
106
Blackish Deposits on Vertebral Column
Metastasis
107
Gleason's Score
Histopathological score used ij PROSTATE cancer
108
How do you differentiate BPH from PROSTATE cancer in H&E?
In PROSTATE CANCER ➡️ Myoepithelial cell layer (Bottom layer) of PROSTATE Glands ⛔ (Single cell lined Glands ➕) ✨ Smaller Glands & Back to Back arrangement
109
Gleason Grading of PROSTATE adenocarcinoma
110
TNM Staging of PROSTATE
111
Staging of PROSTATE cancer done by
1. TNM Staging 2. Jewish & Whitmore Classification
112
Scores in PROSTATE CANCER used for PREDICTING Recurrence in Prostate Cancer
1. Partin Tables 2. D'Amico Score
113
Components of Partin Table & D'Amico Score
1. Serum PSA 2. Clinical Stage 3. Gleason score
114
💊💉 MANAGEMENT of T1 or T2A PROSTATIC Cancer ⭐ Age < 70 yrs ➕ Expected Life Span > 10yrs ➕ G3/G4/G5 Tumour ⭐ Age > 70 yrs ➕ Expected Life Span < 10yrs ➕ G1/G2/G3
⭐ Age < 70 yrs ➕ Expected Life Span > 10yrs ➕ G3/G4/G5 Tumour 🎯 Radical Prostatectomy (Robotic) ⭐ Age > 70 yrs ➕ Expected Life Span < 10yrs ➕ G1/G2/G3 🎯 Observation & Surveillance
115
Structures removed in Radical Prostatectomy
1. Prostate 2. Seminal Vesicles 3. Obturator LN 4. Iliac LN ➕ Anastamose Urethra to Bladder Neck
116
Complication of RADICAL PROSTATECTOMY
1. Sepsis 2. Erectile Dysfunction 3. Incontinence
117
Technique used for PROSTATE Cancer Surgery
Nerve Preserving RALP (Robot Assisted Laparoscopic Prostatectomy) Nerve: Cavernous Nerve
118
💊💉 MANAGEMENT of T2B/ T3/ T4 & N0/1 PROSTATIC Cancer ⭐ Age < 70 yrs ➕ Expected Life Span > 10yrs ➕ G3/G4/G5 Tumour
Brachytherapy ⬇️ ⭐ Good Response: Androgen Deprivation Therapy (ADP) ➕ Observation ⭐ Poor Response: Radical Prostatectomy
119
💊💉 MANAGEMENT of T2B/ T3/ T4 & N0/1 PROSTATIC Cancer ⭐ Age > 70 yrs ➕ Expected Life Span < 10yrs ➕ G1/G2/G3
Brachytherapy (Radiotherapy) ± Androgen Deprivation Therapy
120
⚡⚡ MOST IMPORTANT PROGNOSTIC FACTOR FOR PROSTATE CANCER
Stage of Disease
121
Radiotherapy in PROSTATE cancer
1. Intensity Modulated Radiotherapy (IMRT): 76-86 Gy 2. Brachytherapy
122
Which Radioactive Substance is used for Brachytherapy in PROSTATE
1. Iodine 125 2. Palladium 103
123
Median Survival in Metastatic Prostate Cancer
3-5 years
124
Highest Amount of Radiation Exposure for Therapy of Cancer, is given in
PROSTATE Cancer 76-86 Gy
125
💊💉 MANAGEMENT of METASTATIC PROSTATE cancer
1st Line: Androgen Deprivation Therapy ⬇️ When Tumor becomes RESISTANT to Hormones ⬇️ 2nd Line ⭐ Chemotherapy A. Paclitaxel B. Cabazitaxel ⭐ T-cell vaccine Sipleocel-T ⭐ Radiotherapy
126
Androgen Deprivation Therapy Methods
1. Surgical Castration: B/L Subcapsular Orchidectomy 2. Medical Castration: LHRH Analogue ➕ Anti-androgens ✨ Goserelin ✨ Buserelin Anti-androgens ✨ Flutamide ✨ Enzalutamide ✨ Abiraterone LHRH Antagonist ✨ Degarelix
127
Why LHRH Analogues combined with Anti-androgens?
In Initial Days, Testosterone ⬆️ ⬆️ ⬇️ PSA Flare ✨ To prevent PSA Flare
128
T-cell Vaccine used for
Prostate Cancer ✨ Sipuleocel T (Provenge) ✨ CD54 Extract
129
Radio pharmaceutical Therapy used for
Resistant Bony METASTATIS in PROSTATE cancer
130
Radio pharmaceutical Therapy done with
1. Strontium 89 2. Radium 223
131
Perineural Invasion is seen with which CANCER? 🧠⚡3P⚡
1. PROSTATIC Adenocarcinoma 2. Pancreatic Carcinoma 3. Parotid Gland tumour: Adenoid Cystic Carcinoma
132
E-Cadherin ASSOCIATED Tumours
1. Lobular Carcinoma of Breast 2. Gastric adenocarcinoma 3. PROSTATE adenocarcinoma
133
Tumour MARKER for PROSTATIC CARCINOMA
PSA Organ specific NOT Tumour specific
134
IHC Marker for PROSTATE cancer
1. AMACR: Alpha Methyl Acyl Conenzyme A Racemose 2. TMPRSS2-ERG Fusion DNA 3. PCA3

UROLOGY (12 decks)

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