10. BPH Prostate Ca.pptx sinks one studying

It's very helpful to all medical assistants and students

1. “BPH” Cafterm’s Lecture notes

2. PATTERN OF UROLOGY

3. ANATOMY It is an accessory gland of male reproductive system. It is composed of glandular tissue embedded in fibromuscular stroma. McNeal Divided Prostate into Three Zones • Peripheral zone – prone for carcinoma. • Periurethral transition zone where BPH arises. • Central zone .

4. ANATOMY

5. PROSTATE GLAND Bladder neck pyramidal in shape. Measures 4X3X2cm 10-20gm Zones Mc Neil 1972

6. Mcneal McNeal Divided Prostate into Three Zones • Peripheral zone – prone for carcinoma. • Periurethral transition zone where BPH arises. • Central zone -25% glandular tissue and contains ejaculatory ducts with prostatic urethra

7. PROSTATE Prostatic vessels inferior vesical Valvless veins Batson (3 and 9 O clock) Prostate capsule Denonvilliers Fascia

8. PROSTATE SPECIFIC ANTIGEN (PSA) It is a protease, produced from the prostatic epithelium secreted in the semen to cleave and liquefy the seminal coagulum formed after ejaculation. PSA is organ specific. Normal value is 4 ng/ml of plasma . More than 10 ng/ml is significant .

9. Benign Prostatic Hyperplasia (BPH) It is benign enlargement of prostate which occurs after 50 years, usually between 60 and 70 years.

10. Etiology: Unknown but theories: (1) Hormonal dependent theory : (Role of Androgen) testosterone →5 α- reductase enzyme → 5 DHT → ↑ growth factors → enlargement. (2) Role of estrogen: (Hormonal imbalance) there's associated ↑ of serum estrogen. (↑ E / T Ratio) (3) Programmed cell death regulation: (Apoptosis) ↓ apoptosis (↑ cell growth ) (4) Neoplastic theory: BPH is considered as Bg tumor.

11. Lower urinary tract symptoms (LUTS) Symptoms of voiding • Hesitancy • Intermittent stream –stops and starts Poor flow (not improving by straining) • Dribbling even after micturition Incomplete emptying Dysuria

12. Cont ’ Symptoms of storage Frequency Urgency Nocturia Urge incontinence

13. DRE (Digital Rectal Examination): Prostate size & contour can be assessed (5S) Symmetrically enlarged, Smooth surface, Soft to firm, preserved Sulci, Sliding rectal mucosa over it ) - feel anterior wall of the rectum which lies along posterior prostate -enlarged hard nodules could be prostate cancer

14. Complications. Recurrent hematuria Renal stones Recurrent urinary tract infection Renal failure Retention (acute and chronic) The above are also indications for prostatectomy

15. Investigations: Laboratory : Urine analysis. L iver & kidney function. Urine MCS. PSA (prostate specific Ag) 2. Urodynamic study ( Uroflowmetry ) Q max (peak) = normal > 15 ml / sec. < 10 ml / sec means obstruction to bladder outflow.

16. Cont ’ 3. Imaging: TRUS . (Trans-rectal ultrasound) MRI . IVU : (intravenous urogram) to show back pressure on the kidney . 4. BIOPSY Core needle biopsy

17. Treatment: Prophylaxis : avoid ppt factor e.g. Excess work, worry, weather (cold), wine, women, withholding urine in bladder, spices, constipation . 2. Medical therapy: α 1 - blockers: e.g. Tamsulosin , Alfuzosin . block α- receptors in the urethra → ↓ its tone. 5α- reductase inhibitors: e.g. Finasteride resulting into shrinking of the prostate by converting testosterone to dihydrotestosterone

18. 3. SURGICAL MANAGEMENT Intra prostatic stent Balloon dilatation TURP-Trans Urethral resection of the prostate Trans urethral vaporization Trans urethral incision Open prostatectomy Laser

19. Complications of surgery in BPH Bleeding Urethral stricture Urinary incontinence Erectile dysfunction Retrograde ejaculation

20. Conditions associated with raised PSA Prostate cancer BPH Prostatitis UTI Ejaculation Medical procedures Digital rectal examination

21. THANK YOU Cafterm’s Lecture notes

22. PROSTATE CANCER Cafterm’s Lecture notes

23. Prostate cancer Prostate cancer is the carcinoma of gland that may spread to other parts of the body particularly bones and lymph nodes.

24. RISK FACTORS Obesity Age Family history Low levels of vitamin D Prostatitis Elevated blood levels of testosterone Occupational exposure to chemicals Family history Alcohol & smoking

25. Symptoms Weak or interrupted urine flow Hematuria Nocturia Dysuria Pain in pelvis, spine and ribs Lymphedema Blood in semen ( hematospermia ) Painful ejaculation

26. History Symptoms Late Backache-central back pain Hematospermia LUTS Weight loss

27. Examination DRE Prostate firm to hard, Maybe nodular, Mucosa adherent to prostate Usually enlarged gland Median sulcus obliterated +/- blood gloved finger

28. Grading: According to Gleason score (0-10) 2-4 ‘n well differentiated tumour 5-7 ‘n moderately differentiated 8-10 ‘n undifferentiated tumour

29. Histological Subtypes of Prostate Ca Atrophic Sarcomatoid Signet ring like cell Pleomorphic giant cell Foamy gland Mucinous Pseoudohyperplastic

30. Diagnostic parameters 1. PSA -PSA greater than 10ng/ml 2. DRE : useful in ruling out prostate enlargement caused by benign prostatic hyperplasia 3. PROSTATE BIOPSY 4. MRI/CT SCAN: to assess the extension into the bladder and lymph nodes for staging the cancer and to evaluate bone metastasis.

31. Treatment 1. prostatectomy: removal of prostate gland 2. radiotherapy: radiation directed towards the whole pelvis 3. hormone therapy; 4. anti-androgens 5. chemotheapy

32. C omplications Hemorrhage Hypovolemic shock Infection Pulmonary embolism Sexual dysfunction