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