Prostate Disorders PDF

Prostate disorders BENIGN PROSTATIC HYPERPLASIA  Aetiology Hormones Serum testosterone levels slowly but significantly decrease with advancing age;  Benign prostatic hyperplasia (BPH) Occurs in men over 50 years of age; by the age of 60 years, 50% of men have histologica...

Prostate disorders BENIGN PROSTATIC HYPERPLASIA  Aetiology Hormones Serum testosterone levels slowly but significantly decrease with advancing age;  Benign prostatic hyperplasia (BPH) Occurs in men over 50 years of age; by the age of 60 years, 50% of men have histological evidence of BPH Is a common cause of significant lower urinary tract symptoms in men and is the most common cause of bladder outflow obstruction in men >70 years of age Lower urinary tract symptoms can be described as:  Voiding: hesitancy (worsened if the bladder is very full); poor flow (unimproved by straining); intermittent stream – stops and starts; dribbling (including after micturition); sensation of poor bladder emptying; episodes of near retention. Storage: frequency; nocturia; urgency; urge incontinence; nocturnal incontinence (enuresis) MANAGEMENT OF MEN WITH BENIGN PROSTATIC HYPERPLASIA OR BLADDER OUTFLOW OBSTRUCTION  Acute retention in fit men with no other cause for retention (drugs, constipation, recent operation, etc.)  Chronic retention and renal impairment: a residual urine of 200 mL or more, a raised blood urea, hydroureter or hydronephrosis.  Complications of bladder outflow obstruction: stone, infection and diverticulum formation  Haemorrhage: occasionally, venous bleeding from a ruptured vein overlying the prostate will require prostatectomy to be performed. Elective prostatectomy for severe symptoms: Increasing difficulty in micturition, with considerable frequency day and night, delay in starting and a poor stream are the usual symptoms for which prostatectomy is advised. CARCINOMA OF THE PROSTATE  Carcinoma of the prostate is the most common malignant tumour in men over the age of 65 years. Screening for prostate cancer  The cancer detection rate using measurement of PSA Local spread : Locally advanced tumours tend to grow upwards to involve the seminal vesicles, the bladder neck and trigone Spread by the bloodstream  Spread by the bloodstream occurs particularly to bone; indeed, the prostate is the most common site of origin for skeletal metastases, followed in turn by the breast, the kidney, the bronchus and the thyroid gland. The bones involved most frequently by carcinoma of the prostate are the pelvic bones and the lower lumbar vertebrae. The femoral head, rib cage and skull are other common sites The presentation of men with prostate cancer Often men are asymptomatic, and detection is by opportunistic PSA testing Cancer is detected in men describing lower urinary tract symptoms or may present with symptoms of metastatic disease Clinical features  BOO; pelvic pain and haematuria; bone pain, malaise, ‘arthritis’, anaemia or pancytopenia; renal failure;  Treatment and stage Treatment options for prostate cancer depend on stage of disease, life expectancy of the patient and patient preference Prostate-specific antigen, digital rectal examination and biopsy Gleason grade are used to predict pathological stage Localised cancer can be treated by radical prostatectomy, radiation therapy and active monitoring Treatment of advanced disease is palliative, and hormone ablation remains the first-line therapy PROSTATITIS  Acute prostatitis Aetiology Acute prostatitis is common, but underdiagnosed. The usual organism responsible is Escherichia coli, but Staphylococcus aureus, Staphylococcus albus, Streptococcus faecalis, Neisseria gonorrhoeae or Chlamydia may be responsible. The infection may be haematogenous from a distant focus or it may be secondary to acute urinary infection. Chronic prostatitis Many urologists find the diagnosis of chronic prostatitis and ‘prostatodynia’ very difficult, for many men present with perigenital pain, testicular pain, prostatic pain exacerbated by sexual intercourse or pain that apparently renders sexual intercourse out of the question. Psychosexual dysfunction in such patients may be the underlying problem. The diagnosis of chronic prostatitis has to be based on: persistent threads in voided urine; prostatic massage showing pus cells with or without bacteria in the absence of urinary infection.