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66 Cards in this Set

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  • Back
what part of the prostate is involved in BPH?
transition zone
what are the mechanisms of increased epithelial and stromal cells in periurethral area of prostate gland that occurs in BPH?
epithelial and stromal cell proliferation
impaired apoptosis
t/f... androgens cause BPH
false, there is a permissive but not causative effect
what can cause a partial regression of BPH?
surgical or biochemical castration
pharmacological inhibition of 5 alpha reductase
in what situations will men not develop BPH?
castrated before puberty
5alpha reductase deficiency
what acts synergistically with DHT to produce BPH?
oestradiol
what percentage of men aged 60 have BPH?
50%
what percentage of men aged 85 have BPH?
100%
how many men aged 85 have BPH requiring surgery?
25%
t/f... the majority of men under 50 with lower urinary tract symptoms have BPH
false, majority have a different cause
what are the drug therapies for BPH?
herbal remedies (limited quality data)
5 alpha reductase inhibitors (finasteride, dutasteride)
anti-androgens
alpha blockers
what are the advantages of minimally invasive therapy for BPH?
better outcomes than drug treatment
low morbidity
more rapid return to normal activities
potential for office based treatment
what are the disadvantages of minimally invasive therapy for BPH?
cost
only modest improvements in symptoms and flow rates
high re-treatment rates
no long term outcome data
what are the familial risk factors for BPH?
large prostate size
earlier age of surgery
what percentage of men over 60 will have microscopic changes of BPH?
50%
what percentage of men over 85 will have microscopic changes of BPH?
100%
what percentage of men over 85 have macroscopic BPH?
53%
what percentage of men over 85 have BPH requiring surgery?
25%
which drugs reduce the size of prostate in BPH?
finasteride
anti-androgens
which drugs used in BPH reduce the urethral resistance?
alpha blockers
what are the main advantages of minimally invasive therapy for BPH?
significantly better outcomes than drug treatment
low morbidity
more rapid return to normal activities
potential for office based treatment
what effect does BPH have on the detrusor?
hypertrophy and development of trabeculations and diverticula
t/f... the ductus deferens passes through the prostate
false
what is formed by the ductus deferens and the seminal vesicle to pass through the prostate?
ejaculatory duct
how much fluid is contributed by the prostate?
15-30%
what zone of the prostate is more commonly involved in cancer?
peripheral zone
what is the venous drainage of the prostate?
mainly internal iliac vein (and internal vertebral venous plexus)
by how much does a person's risk of prostate cancer increase with a positive family history (one and two first degree relatives)?
one 1st degree relative - x2
two - x9
what findings on PR may indicate prostate cancer?
hard consistency
asymmetry
nodularity
t/f... PSA is highly specific but not very sensitive for prostate cancer
false, the converse is true
what percentage of patients with a PSA between 4 and 10 and a positive rectal examination will have prostate cancer?
30%
t/f... PSA is a good screening test for prostate cancer
false
what is the positive predictive value for prostate cancer of a positive rectal exam?
6%
what is the positive predictive value for prostate cancer of an elevated PSA?
20%
what is the positive predictive value for prostate cancer of a positive rectal exam and an elevated PSA?
30%
what are the treatment options for T1 and T2 prostate cancer?
watchful waiting
hormonal
radiotherapy
radical prostatectomy
which Gleason scores indicate a patient will probably die from prostate cancer (not with it)?
gleason score > 6
what are the complications of radical prostatectomy?
mortality 0.7%
impotence 30-70%
incontinence 2% severe, 20% mild
bladder neck stricture 5%
bowel injury 1%
what is removed in a radical prostatectomy?
bladder neck, prostate, lymph nodes, seminal vesicles
what is the mainstay of treatment for T3 and T4 prostate cancer?
radiotherapy
what is the difference (in terms of complications) between radiotherapy and radical prostatectomy?
radiotherapy - patient develops complications gradually after surgery
radical prostatectomy - patient develops complications straight away but they gradually improve
what is the mainstay of treatment for advanced prostate cancer (N and M stages)?
androgen ablation (medical or surgical)
what is the treatment for painful mets of prostate cancer?
radiotherapy
strontium
corticosteroids
palliation
when is prostate development completed?
week 25
where in the prostate does benign prostatic hyperplasia occur?
transitional zone
what mediates the conversion of testosterone to dihydrotestosterone in the prostate?
5 alpha reductase
which cells in the prostate produce secretions?
epithelial cells
how much does finasteride shrink the prostate by?
20%
what goes through the prostate?
prostatic urethra
two ejaculatory ducts (terminal portions of vas deferens)
where do the ejaculatory ducts exit the prostate?
verumontanum
what are the three glandular zones of the prostate?
central
transition
peripheral
where does most prostate cancer arise from?
peripheral zone
what is the blood supply to the prostate?
branches of the internal iliac arteries
what is the venous drainage of the prostate?
dorsal vein of penis
which stages of prostate cancer are incurable?
T4, N or M
t/f... prostate cancer with a stage of T3 is always incurable
false, it is occasionally curable
what Gleason score do most clinical prostate cancers have?
5-7
how does prostate cancer spread?
local extension
lymphatics
blood
where does prostate cancer spread?
bone
what are the common sites for bone mets of prostate cancer?
pelvic bone
thoraco-lumbar vertebrae
ribs
what percentage of all male cancer is prostate?
24%
what percentage of male cancer deaths is due to prostate cancer?
11%
t/f... incidence of prostate cancer is rising sharply
true
what supports the prostate laterally?
levator ani muscle
what is the blood supply to prostate?
branches of internal iliac arteries (drains to internal iliac veins)
what is the lymphatic drainage of the prostate gland?
internal and external iliac nodes