Prostate (From 2Nd Year)

Front 1

what part of the prostate is involved in BPH?

Back 1

transition zone

Front 2

what are the mechanisms of increased epithelial and stromal cells in periurethral area of prostate gland that occurs in BPH?

Back 2

epithelial and stromal cell proliferation
impaired apoptosis

Front 3

t/f... androgens cause BPH

Back 3

false, there is a permissive but not causative effect

Front 4

what can cause a partial regression of BPH?

Back 4

surgical or biochemical castration
pharmacological inhibition of 5 alpha reductase

Front 5

in what situations will men not develop BPH?

Back 5

castrated before puberty
5alpha reductase deficiency

Front 6

what acts synergistically with DHT to produce BPH?

Back 6

oestradiol

Front 7

what percentage of men aged 60 have BPH?

Back 7

50%

Front 8

what percentage of men aged 85 have BPH?

Back 8

100%

Front 9

how many men aged 85 have BPH requiring surgery?

Back 9

25%

Front 10

t/f... the majority of men under 50 with lower urinary tract symptoms have BPH

Back 10

false, majority have a different cause

Front 11

what are the drug therapies for BPH?

Back 11

herbal remedies (limited quality data)
5 alpha reductase inhibitors (finasteride, dutasteride)
anti-androgens
alpha blockers

Front 12

what are the advantages of minimally invasive therapy for BPH?

Back 12

better outcomes than drug treatment
low morbidity
more rapid return to normal activities
potential for office based treatment

Front 13

what are the disadvantages of minimally invasive therapy for BPH?

Back 13

cost
only modest improvements in symptoms and flow rates
high re-treatment rates
no long term outcome data

Front 14

what are the familial risk factors for BPH?

Back 14

large prostate size
earlier age of surgery

Front 15

what percentage of men over 60 will have microscopic changes of BPH?

Back 15

50%

Front 16

what percentage of men over 85 will have microscopic changes of BPH?

Back 16

100%

Front 17

what percentage of men over 85 have macroscopic BPH?

Back 17

53%

Front 18

what percentage of men over 85 have BPH requiring surgery?

Back 18

25%

Front 19

which drugs reduce the size of prostate in BPH?

Back 19

finasteride
anti-androgens

Front 20

which drugs used in BPH reduce the urethral resistance?

Back 20

alpha blockers

Front 21

what are the main advantages of minimally invasive therapy for BPH?

Back 21

significantly better outcomes than drug treatment
low morbidity
more rapid return to normal activities
potential for office based treatment

Front 22

what effect does BPH have on the detrusor?

Back 22

hypertrophy and development of trabeculations and diverticula

Front 23

t/f... the ductus deferens passes through the prostate

Back 23

false

Front 24

what is formed by the ductus deferens and the seminal vesicle to pass through the prostate?

Back 24

ejaculatory duct

Front 25

how much fluid is contributed by the prostate?

Back 25

15-30%

Front 26

what zone of the prostate is more commonly involved in cancer?

Back 26

peripheral zone

Front 27

what is the venous drainage of the prostate?

Back 27

mainly internal iliac vein (and internal vertebral venous plexus)

Front 28

by how much does a person's risk of prostate cancer increase with a positive family history (one and two first degree relatives)?

Back 28

one 1st degree relative - x2
two - x9

Front 29

what findings on PR may indicate prostate cancer?

Back 29

hard consistency
asymmetry
nodularity

Front 30

t/f... PSA is highly specific but not very sensitive for prostate cancer

Back 30

false, the converse is true

Front 31

what percentage of patients with a PSA between 4 and 10 and a positive rectal examination will have prostate cancer?

Back 31

30%

Front 32

t/f... PSA is a good screening test for prostate cancer

Back 32

false

Front 33

what is the positive predictive value for prostate cancer of a positive rectal exam?

Back 33

6%

Front 34

what is the positive predictive value for prostate cancer of an elevated PSA?

Back 34

20%

Front 35

what is the positive predictive value for prostate cancer of a positive rectal exam and an elevated PSA?

Back 35

30%

Front 36

what are the treatment options for T1 and T2 prostate cancer?

Back 36

watchful waiting
hormonal
radiotherapy
radical prostatectomy

Front 37

which Gleason scores indicate a patient will probably die from prostate cancer (not with it)?

Back 37

gleason score > 6

Front 38

what are the complications of radical prostatectomy?

Back 38

mortality 0.7%
impotence 30-70%
incontinence 2% severe, 20% mild
bladder neck stricture 5%
bowel injury 1%

Front 39

what is removed in a radical prostatectomy?

Back 39

bladder neck, prostate, lymph nodes, seminal vesicles

Front 40

what is the mainstay of treatment for T3 and T4 prostate cancer?

Back 40

radiotherapy

Front 41

what is the difference (in terms of complications) between radiotherapy and radical prostatectomy?

Back 41

radiotherapy - patient develops complications gradually after surgery
radical prostatectomy - patient develops complications straight away but they gradually improve

Front 42

what is the mainstay of treatment for advanced prostate cancer (N and M stages)?

Back 42

androgen ablation (medical or surgical)

Front 43

what is the treatment for painful mets of prostate cancer?

Back 43

radiotherapy
strontium
corticosteroids
palliation

Front 44

when is prostate development completed?

Back 44

week 25

Front 45

where in the prostate does benign prostatic hyperplasia occur?

Back 45

transitional zone

Front 46

what mediates the conversion of testosterone to dihydrotestosterone in the prostate?

Back 46

5 alpha reductase

Front 47

which cells in the prostate produce secretions?

Back 47

epithelial cells

Front 48

how much does finasteride shrink the prostate by?

Back 48

20%

Front 49

what goes through the prostate?

Back 49

prostatic urethra
two ejaculatory ducts (terminal portions of vas deferens)

Front 50

where do the ejaculatory ducts exit the prostate?

Back 50

verumontanum

Front 51

what are the three glandular zones of the prostate?

Back 51

central
transition
peripheral

Front 52

where does most prostate cancer arise from?

Back 52

peripheral zone

Front 53

what is the blood supply to the prostate?

Back 53

branches of the internal iliac arteries

Front 54

what is the venous drainage of the prostate?

Back 54

dorsal vein of penis

Front 55

which stages of prostate cancer are incurable?

Back 55

T4, N or M

Front 56

t/f... prostate cancer with a stage of T3 is always incurable

Back 56

false, it is occasionally curable

Front 57

what Gleason score do most clinical prostate cancers have?

Back 57

5-7

Front 58

how does prostate cancer spread?

Back 58

local extension
lymphatics
blood

Front 59

where does prostate cancer spread?

Back 59

bone

Front 60

what are the common sites for bone mets of prostate cancer?

Back 60

pelvic bone
thoraco-lumbar vertebrae
ribs

Front 61

what percentage of all male cancer is prostate?

Back 61

24%

Front 62

what percentage of male cancer deaths is due to prostate cancer?

Back 62

11%

Front 63

t/f... incidence of prostate cancer is rising sharply

Back 63

true

Front 64

what supports the prostate laterally?

Back 64

levator ani muscle

Front 65

what is the blood supply to prostate?

Back 65

branches of internal iliac arteries (drains to internal iliac veins)

Front 66

what is the lymphatic drainage of the prostate gland?

Back 66

internal and external iliac nodes