Session 11b Prostate

Question 1

Epidemiology of prostate cancer

Answer 1

Commonest cancer in men

2nd commonest cause of death from cancer in men

1/8 men diagnosed in their lifetime

Rare in men under 50

Question 2

Risk factors for prostate cancer

Answer 2

Increased age
FH (BRACA2 gene mutation)
Ethnicity- black>white>asian

Question 3

Label

Answer 3

Question 4

Prostate cancer lesions are commonly found in the

Answer 4

Periphery of posterior part of prostate

Question 5

Prostate cancer lesions are more commonly found in the

Answer 5

Periphery of the posterior part

Question 6

BPH usually found

Answer 6

Central

Question 7

Presentation of prostate cancer

Answer 7

Symptoms of UTI, prostatism, metastatic disease in bone (spine) causing bone pain

Question 8

Increasingly, carcinoma of prostate is found following

Answer 8

Investigation of elevated prostate-specific antigen (PSA) in otherwise asymptomatic men

Question 9

Differential diagnoses:

65 y/o, hesitancy, nocturia, weight loss, lower back pain

Answer 9

BPH
Prostate cancer

Prostatitis
Urethral stricture
Multiple myeloma

Neurological: CVA, Parkinson’s, spinal cord compression

Question 10

questions to identity BPH or prostatic cancer

Answer 10

Family history

hormone use- increased testosterone

Haematuria

Bone pains elsewhere

Question 11

Examination for BPH or prostate cancer

Answer 11

Digital rectal examination

Question 12

DRE of prostate cancer

Answer 12

Enlarged prostate, hard and irregular, obliteration of median sulcus

(should be smooth and plum sized, feel 2 different lobes)

Question 13

DRE in BPH

Answer 13

A lot larger and maybe firmer

Question 14

Causes of a raised PSA

Answer 14

Prostate cancer
Infection
Inflammation
Large prostate
Urinary retention

Question 15

PSA comes back as 35, what does this mean

Answer 15

Normal range is less than 40 for a 60-69 year old

More than 80% chance of prostate cancer as so high

Question 16

Doing DRE can cause

Answer 16

Raised PSA

Question 17

What else can cause elevated PSA

Answer 17

UTI
Inflammation
Large prostate BPH
Urinary retention

Question 18

Presentation of prostate cancer

Answer 18

Urinary symptoms
Bone pain
Raised PSA,biopsy

Opportunistic finding from DRE
Incidental finding at transurethral resection of prostate

Question 19

Grading of prostate cancer

Answer 19

Gleason classification grades 1-5

TNM system

Question 20

Diagnosis of prostate cancer

Answer 20

DRE
Ultrasound
Increased PSA?
Biopsy

Radiographs and bone scans- osteoslcerotic lesions on radiographs and increased isotope uptake on both scans are seen if there is metastatic spread

Question 21

Patients in advanced prostate cancer stages can develop

Answer 21

Sclerotic bone legion- hot spots on bone scan

Question 22

Treatment for localised prostate cancer

Answer 22

Surgery, hormone therapy, radiotherapy

Surveillance

Question 23

Treatment of T1/T2 prostate cancer

Answer 23

Radical surgical resection maybe curative, TURP may be required

Question 24

Treatment of advanced prostate cancer

Answer 24

Hormonal manipulation is beneficial since testosterone promotes tumour growth (testosterone, dihydrotestosterone)

Surgical castration, medical castration (LNRH or GnRH agonist)

Palliative care

Question 25

Prognosis for prostate cancer

Answer 25

5 year survival for T1 = 75-90% 5 year survival falls to 30-45% if local of metastatic spread

Question 26

Side effects of castration

Answer 26

Hot flushes Impotence Thinning of bones Diminished muscle mass Increase in breast size Weight gain Mood changes

Question 27

features of Polycystic kidney disease

Answer 27

8-10% of CKD Most common inherited nephropathy

Question 28

Presentation of Polycystic kidney disease

Answer 28

30-40 years of age with hypertension, acute loin pain, haematuria or bilateral palpable kidneys

Question 29

Pathology of Polycystic kidney disease

Answer 29

Cysts develop anywhere in kidney, compress surrounding parenchyma and impair renal function Tubule cannot properly drain into CD

Question 30

Autosomal dominant and recessive Polycystic kidneys

Answer 30

Dominant: 1/500-1000 Recessive: 1/20000-40000

Question 31

Cysts are seen in kidneys and

Answer 31

Liver/ovaries

Question 32

Macroscopic findings Polycystic kidney disease

Answer 32

Large with yellow fluid-filled cysts replacing the parenchyma Haemorrhage into cysts can occur

Question 33

Microscopic findings Polycystic kidney disease

Answer 33

Cysts lined with cuboidal epithelium

Question 34

USS or CT scan in Polycystic kidney disease

Answer 34

Bilateral enlarged kidneys with multiple cysts

Question 35

What is the most likely cause of pain and macroscopic haematuria

Answer 35

Adult Polycystic kidney disease Cysts can begin to form in childhood but not clinically evident until adulthood Cysts can fill with blood following trauma, resulting in severe abdominal pain and macroscopic haematuria Cysts can become infected

Question 36

Further aspects of history to explore with APKD

Answer 36

Can cause hypertension and CKD, cysts in other organs, inherited (family member dying of berry aneurysm/brain haemorrhage, kidney problems etc) Associated with valvular heart disease, diverticular disease, berry aneurism. Any history of stroke/cerebral haemorrhage should be sought

Question 37

Outcomes in APKD

Answer 37

Morbidity and mortality result of hypertension, e.g. MI and cerebrovascular disease Condition also leads to progressive CKD Treatment involves controlling BP Dialysis and renal transplant needed in end stage renal failure develops

Question 38

Immediate management of APKD

Answer 38

Pain control- clots in the renal collecting system causes renal colic IV fluids to increase urine output, attempt to wash clot out

Question 39

Information given to APKD

Answer 39

Possibility of recurrent episodes of macroscopic haematuria, given advice on management at home with simple analgesia and oral hydration Advise to avoid contact sports in which abdominal trauma may occur (Rugby, boxing)

Question 40

What issues need to be addressed in follow up of APKD

Answer 40

Hypertensive, ECG changes consistent with LVH treatment of bp recommended for adults with BP >130/80, ACEI preferred, can preserve renal function in patients with APKD

Question 41

Is genetic screening useful for PKD

Answer 41

Genetic screening not useful unless large number of family members with disease Screen on annual basis for elevated BP or urine dipstick abnormalities Late teens: ultrasound, absence of cysts at this stage would make disease unlikely Repeated when >30 years, still no cysts = APKD virtually excluded