When I grow up.. I wannabe a Dr.

Five guys. Malaysians. Once medical students. Once stuck in a house in Summerstown Cork. NOW all Doctors, going separate ways. What will they be up to?? ish macam macam.....

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Wednesday, March 25

Prostate Cancer etc

cakap-cakap shahied

Urology outpatients dept today.
I was a bit late bcoz had a bedside tutorial looking at different kind of drains, wounds and stuff.
So when i got there, there was already this 4th med girl there inside with the consultant.
The consultant then said that he can only have one student with him so told us to decide who should stay and who should go with his registrar instead.
I looked at her and she doesn't seem like she wants to budge/give up the oppoturnity to sit in with the consultant so i volunteered. Well, i don't blame her. We threw them out earlier for the bedside teaching because it would be too big of a group if they joined in as well(we politely said, shooh shooh ;p)
The registrar wasn't bad at all. He explained all his patients problem and management and delighted to take questions.
A few of the patients had prostate cancer diagnosed. So here are the few things that i could remember from the top of my head.

Prostate Cancer

Presentation: Can be asymptomatic, found incidentally usually on PSA testing or digital rectal examination
(all the patient that had the diagnosis today were incidental findings)
Those with symptoms can include: frequency, nocturia, dribbling, incontinence.
Those that present late could have: loss of weight, bony pain(due to metastasis)

So the usual story is they would usually have got PSA testing which showed increase PSA level.
Next they would have a DRE(digital rectal examination) to feel their prostate gland.
Then they would have a TRUS(transrectal ultrasound) guided biopsy
The sample would be examined histologically to see if there is cancer or not.

So it happens the prostate biopsy showed prostate cancer. Usually adenocarcinoma. What next?
First option is of course surgery. Removal of the prostate. But not everyone is suitable for surgery.
These are the criteria for undergoing surgery:
1. Age <65
2. PSA level <10
3. Gleason Score <6
4. No/minimal medical comorbidity

For those who are not suitable for surgery, hormonal treatment and radiotherapy is the next option.
Hormonal therapy usually involves:
1. 4 week course of antiadrogen injection (Casodex)
2. 2 course of LHRH analog (Eligard) every 6 month lifelong. (Apparently he said that Goserelin is not used here in Cork)
They will then be monitored every 6 month for their PSA level. Radiotherapy option can be done if they want it.

So thats about it that i could remember.


So i finally saw something i never have seen before today. 
Port wine stain associated with Sturge Weber syndrome, in Urology clinic.
This lady actually came in with problem of incontinence. Just so happens that she has Sturge Weber Syndrome.
True the saying that once you see one, you never forget one.
Sturge Weber syndrome or its longer name Encephalotrigeminal Angiomatosis is Port Wine Staining usuall around the trigeminal distribution associated with contralateral focal seizures(due to angimomas in the brain), glaucoma and learning disabilities. She's taking detrusitol for the bladder, and as you might know, it is an anticholinergic which can exacerbate glaucoma(another good learning point). Apparently, thats the only anticholinergic that doesn't cause problem with her glaucoma.why?i don't know.

baby with port wine stain

hope you guys learnt something. 


1 kritikus:

fendi said...

a great share indeed! in which it reminds me of this great PSA (public service announcement)~

Prostate Cancer PSA