Prostate and cards Flashcards
(29 cards)
What are the male LUTS?
Nocturia, frequency, urgency, post-micturition dribbling, poor stream/flow, hesitency, overflow incontinence
What tests should be done in a male presenting with LUTS?
Need to assess impact on life and do PR
MSU, u and e, ultrasound bladder, PSA (prior to PR)
Transrectal ultrasound +/- biopsy
What is the non surgical management for BPH?
Lifestyle: avoid caffine/ alcohol as increases urgency, relax when voiding, train the bladder to hold on
Drugs: alpha blockers e.g. tamsulosin decrease smooth muslce tone
5 alpha reductase inhibitors - decreases prostate size over months
What is the surgical management of BPH?
transurethral recetion of prostate - may cause impotence, erectile dysfunction and retrograde ejaculation
Transurethral incision of prostate
Retropubic prostatectomy
What advice should be given after a transurethral resection of the prostate?
Avoid driving for 2 weeks
Avoid sex for 2 weeks
Reduced semen volume from retrograde ejaculation
Haematuria normal
Initially increased frequency of urination
Where does BPH occur in the prostate vs cancer?
BPH centrally, cancer peripherally
What type are most prostate cancers and how do they spread?
Most are adenocarcinomas in the peripheral prostate, they spread to the local area via lymph (seminal vesicles, bladder, rectum) or haematogenously to the bone (Spine)
What are some of the symptoms of prostate cancer?
Can be asymptomatic or nocturia, heistency, poor flow, terminal dribbling or obstruction
Decreased weight and bone pain suggests mets
How is a diagnosis of prostate cancer made?
It is a combination of DRE findings (hard, irregular)
Increased PSA (can be normal)
Transrectal ultrasound/biopsy
CT/MRI
How is staging for prostate cancer done?
This is done by MRI
How is prostate cancer treated?
In disease confined to prostate:
-Radical prostatectomy
-Radical radiotherapy (external beam or brachytherapy) with neo adjuvant and adjuvant hormonal therapy
-Hormonal therapy alone - delays further tumour growth
Metastatic:
-hormonal therapy can help, radiotherapy for spinal mets
What are the PSA agegroup cutoffs?
50-59 years - <3ng/ml
60-69 years - <4ng/ml
Above 70 - <5ng/ml
NICE reccommends over 3 gets referral for all ages
What is the likelihood of a PSA beign accurate?
Only one third of those with raised PSA will actually have prostate cancer
What are the features of renal cell cancer?
Often asymptomatic and found incidentally Haematuria Loin pain Abdo mass Anorexia Malaise weight loss Cancompress left renal vein and cause varicocoele
What are the tests for renal cell carcinoma?
Bloods -FBC polycythaemia from epo, ESR, u and E BP raised from renin secretion Urine - RBCs Imaging - US MRI - canon ball mets
What is the treatment of renal cell carcinoma?
Radical nephrectomy
Can use ablation or cryotherapy for patients not fit for surgery
Generally radio/chemo resistent
For those that have metastasised, try T cell activation therapies
Where do transitional cell carcinomas arise?
Bladder (50%), ureter or renal pelvis
How do transitional cell carcinomas present?
With painless haematuria, recurrent UTIs, voiding irritability
How is a diagnosis of transitional cell carcinoma made?
Cystoscopy with biopsy is diagnostic
CT urogram is both diagnostic and provides staging
MRI can show involved nodes
How is transitional cell carcinoma treated?
If confined to the epithelium or submucosa:
-Transurethral resection of bladder tumour
-Intravesical BCG immunotherapy can provoke immune attack
If invading:
-Radical cystectomy is gold standard
What is a cause of an abdominal mass and haematuria in a child?
A nephroblastoma (Wilms tumour)
How dos penile cancer present?
With chronic fungating ulcer, bloody discharge
50% spread to lymph at presentation
What is the treatment fo penile cancer?
Radiotherapy if early, amputation and lymph node dissection if late
What are some of the prognostic factors to determine treatment in prostate cancer?
PSA level pretreatment
TNM
Tumour grade (gleason score)
