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Questions and Answers
What is the age range where benign prostatic hyperplasia (BPH) commonly occurs?
What is the most common cause of bladder outflow obstruction in men over 70 years of age?
What is the name of the condition where there is a sudden inability to urinate, often requiring immediate treatment?
What is the term for the sensation of poor bladder emptying?
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What is the age range where 50% of men have histological evidence of benign prostatic hyperplasia (BPH)?
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What is the term for the formation of small, fluid-filled pouches in the bladder wall?
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What is the age range where carcinoma of the prostate is the most common malignant tumour?
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What is the term for the need to urinate frequently during the night?
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What is the most common site of origin for skeletal metastases?
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Which of the following is NOT a common site of bone involvement in prostate cancer?
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What is the primary method of detection for prostate cancer in asymptomatic men?
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What is the usual organism responsible for acute prostatitis?
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What is the primary treatment option for advanced prostate cancer?
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Which of the following is a symptom of metastatic disease in prostate cancer?
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What is used to predict the pathological stage of prostate cancer?
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What is the typical route of infection in acute prostatitis?
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Study Notes
Benign Prostatic Hyperplasia (BPH)
- BPH occurs in men over 50 years old, with 50% of men showing histological evidence by the age of 60.
- Lower urinary tract symptoms (LUTS) associated with BPH include:
- Voiding symptoms: hesitancy, poor flow, intermittent stream, and dribbling
- Storage symptoms: frequency, nocturia, urgency, urge incontinence, and nocturnal incontinence
- BPH is the most common cause of bladder outflow obstruction in men over 70 years old.
Management of Men with BPH or Bladder Outflow Obstruction
- Acute retention in fit men without other causes (e.g., drugs, constipation, recent operation)
- Chronic retention and renal impairment: residual urine of 200 mL or more, raised blood urea, hydroureter, or hydronephrosis
- Complications of bladder outflow obstruction: stone, infection, and diverticulum formation
- Haemorrhage: venous bleeding from a ruptured vein overlying the prostate may require prostatectomy
- Elective prostatectomy for severe symptoms: increasing difficulty in micturition, frequency, and poor stream
Carcinoma of the Prostate
- Carcinoma of the prostate is the most common malignant tumor in men over 65 years old
- Screening for prostate cancer involves measurement of PSA (prostate-specific antigen)
- Local spread: locally advanced tumors tend to grow upwards to involve the seminal vesicles, bladder neck, and trigone
- Spread by the bloodstream: particularly to bone, with the pelvic bones and lower lumbar vertebrae being the most frequently involved sites
Presentation and Clinical Features of Prostate Cancer
- Men are often asymptomatic, with detection occurring through opportunistic PSA testing
- Cancer may be detected in men describing lower urinary tract symptoms or presenting with symptoms of metastatic disease
- Clinical features: BOO, pelvic pain, haematuria, bone pain, malaise, ‘arthritis’, anaemia, pancytopenia, and renal failure
Treatment and Stage of Prostate Cancer
- Treatment options depend on stage of disease, life expectancy, and patient preference
- Prostate-specific antigen, digital rectal examination, and biopsy Gleason grade are used to predict pathological stage
- Localized cancer can be treated by radical prostatectomy, radiation therapy, and active monitoring
- Treatment of advanced disease is palliative, with hormone ablation being the first-line therapy
Prostatitis
- Acute prostatitis is common but underdiagnosed
- Usual organisms responsible: Escherichia coli, Staphylococcus aureus, Staphylococcus albus, Streptococcus faecalis, Neisseria gonorrhoeae, or Chlamydia
- Infection may be haematogenous from a distant focus or secondary to acute urinary infection
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Description
This quiz covers the aetiology and characteristics of Benign Prostatic Hyperplasia, a common cause of lower urinary tract symptoms in men over 50 years old. Learn about the effects of hormone levels and age on BPH.