Prostate disease
Benign prostatic hypertrophy
Prostatic carcinoma
Benign prostatic hypertrophy
Demographics
14% in 40's
24% in 50's
49% in 60's
Pathology
Enlargement of transitional zone.
Symptoms
Obstructive
Irritative
Poor stream
Straining
Hesitancy
Terminal dribbling
Retention
Frequency
Urgency
Nocturia
Urge incontinence
Obstructive symptoms are relieved by TURP, but irritative symptoms only relieved in 1/3.
Natural history
55% progress
30% stable
15% improve
Investigations
Urine: urinalysis
Blood: U&E, PSA
Peak flow rate (<12 ml/sec)
Residual vol US
Consider urodynamics
Consider transrectal US if ↑PSA
PSA lower limits: 40's 2.5, 50's 3.5, 60's 4.5, 70's 6.5.
4–10 20% risk, >10 60% risk.
Alternatively: free:total PSA ratio. ↓ → Ca.
Treatment
Watchful waiting
α-blockers, 5α-reductase inhibitors, saw palmetto.
Surgery: bladder neck incision, TURP.
Prostatic carcinoma
Diagnosis
Transrectal biopsy (sextant). Prophylactic antibiotics.
Staging
T1: Confined to prostate
T2: Palpable
T3: Outside prostate
T4: Fixed
Grading
Gleason grade 1–5. Gleason score = add grade from two areas.
2, 3 benign
4–7 treat
8–10 treat. Poor prognosis
Prostate specific antigen
<40 → no metastases
>40 → metastases
Also do scintigram pelvis, lumbar spine.
Treatment
T1, T2: radical prostatectomy, radical radiotherapy
T3, T4: hormones, radiotherapy
Metastases: (50% at presentation) hormones, orchidectomy, LHRH analogues, oestrogens.