Mindmaps Prostatic Hyperplasia and Prostate cancer

Question 1

What is Benign Prostatic Hyperplasia

Answer 1

Benign enlargement of the prostate gland, particularly in the transitional zone
Common with increasing age

Question 2

Cause and pathophsyiology of BPH

Answer 2

Hypertrophy of the epithelial and stromal cells of the prostate gland
Classically occurs in the transitional zone of the prostate gland and is thought to be driven by the androgen dihydrotestosterone

Question 3

What zone of the prostate is most often site of BPH

Answer 3

Transitional zone

Question 4

Signs and symptoms of BPH or non-metastasised prostate cancer

Answer 4

FUN BOO:
Frequency
Urgency
Nocturia
those of Bladder Outflow Obstruction:
Hesitancy
Intermittent flow/poor urine stream/dribbling
Incomplete bladder emptying

Question 5

Complications of BPH

Answer 5

Urinary retention
Recurrent UTIs
Impaired renal function
Haematuria

Question 6

Investigations of BPH

Answer 6

Per rectum examination
Urine dipstick, microscopy and culture
Bloods
Prostate specific antigen (PSA) - usually raised
Radiology - ultrasound scan of the urinary tract, transrectal ultrasound scan

Question 7

What would found in a per rectum examination of someone with BPH

Answer 7

An enlarged but smooth prostate gland with a palpable midline sulcus

Question 8

Blood investigations of BPH

Answer 8

FBCs
U and Es
Creatinine (renal function)
LFTs

Question 9

Conservative management of BPH

Answer 9

Conservative: Watchful waiting is usually adopted in mild disease
Then generally:
*Completion of the International Prostate Symptom Score (IPSS). Completion of a voiding diary to see if patient is bothered by their symptoms.

Question 10

Medical treatment of BPH

Answer 10

Alpha 1-adrenoreceptor blockers e.g. tamsulosin

5 alpha-reductase inhibitor e.g. finasteride

Question 11

Surgical treatment of BPH

Answer 11

Transurethral resection of the prostate (TURP)

Question 12

Most common site of prostate cancers

Answer 12

Peripheral zone of prostate gland

70-80% of prostate cancers

Question 13

Sites of prostate cancers

Answer 13

Peripheral zone (70-80%)
Transitional zone (10-20% all prostate cancers and most common site for BPH)
Central zone (2.5%)

Question 14

Characteristics of prostate cancer of central zone

Answer 14

Aggressive

Spread to seminal vesicles

Question 15

What is prostate cancer

Answer 15

Usually an adenocarcinoma that arises from the peripheral zone of the prostate gland

Question 16

Risk factors of prostate cancer

Answer 16

Increasing age
Family Hx or prostate cancer
More common in African populations

Question 17

Signs and symptoms of metastatic prostate cancer

Answer 17

Weight loss
Malaise and fatigue
Usually spreads to the bone, therefore bone pain (pathological fracture)

Question 18

Complications of prostate cancer

Answer 18

Metastasis
Death
Urinary incontinence
Erectile dysfunction

Question 19

Investigations of prostate cancer

Answer 19

Per rectum examination
Urine dipstick, microscopy and culture
Bloods
Prostate Specific Antigen (PSA) - usually raised
Radiology - transurethral ultrasound and biopsy

Question 20

What would you see on per rectum examination of prostate cancer (and how is it different to BPH)

Answer 20

An enlarged prostate gland that may be uni-nodular or multi-nodular.
Midline sulcus is usually no longer palpable (unlike BPH where is usually is).

Question 21

What would happen if transrectal ultrasound and biopsy where to detect a malignany?

Answer 21

Patient should be sent for a MRI and bone scan to look for distant metastases

Question 22

How is prostate cancer staged

Answer 22

TMN system

Question 23

Conservative management of prostate cancer

Answer 23

Involvement of Macmillan nurses and psychological support

Question 24

Medical management of prostate cancer

Answer 24

Radiotherapy
Brachytherapy
Goserelin (Zoladex) - a luteinising hormone-releasing hormone (LHRH) agonist
Anti-androgens e.g. cyproterone

Question 25

Surgical management of prostate cancer

Answer 25

Laproscopic radical prostatectomy

Transurethral resection of the prostate (TURP)

Question 26

2 pharmacological therapies of BPH (type and example)

Answer 26

5-alpha reductase inhibitors - Finasteride

Alpha blockers - tamsulosin

Question 27

Give 2 difference on digital rectal examination of BPH and Prostate carcinoma

Answer 27

BPH = smooth + regular shaped
Carcinoma = hard + irregular shaped

Question 28

Tests of BPH

Answer 28

Prostate Specific Antigen Test
Ultrasound scan of urinary tract and prostate
Trans-rectal ultrasound guided biopsy