What percentage of total serum testosterone is unbound in plasma?
Testosterone in blood is bound to strongly to SHBG and loosely to albumin. Only 1%–4% is free. Testosterone is loosely bound to albumin (and other plasma proteins) and therefore forms part of the bioavailable testosterone (BAT). Serum hormone binding globulin (SHBG) binds to 2/3 of the total testosterone. Free testosterone measures the free fraction, bioavailable testosterone includes free plus the weakly bound to albumin. Di-hydro testosterone (DHT) is the major form of androgens found within the prostate gland, the concentration is five times that of testosterone. Testosterone is converted to DHT by the action of 5 alpha reductase.
Which of the following is TRUE with respect to BPH?
Benign prostatic hyperplasia is a histological process characterised by an increase in the number of epithelial and stromal cells in the periurethral area of the prostate. New gland formation is usually only seen in the foetus, which has led to the theory of ‘embryonic reawakening’. The increase in cell number may be due to cellular proliferation or apoptosis or a combination of the two. The development of BPH requires androgens during prostate development, puberty and aging. Patients castrated prior to puberty do not develop BPH. Hald’s 3-ring diagram originally described the relationship between hyperplasia, prostatism and obstruction. It has now been modified to include the relationship between LUTS, BPE and BOO: only 25%–50% of men with BPH have LUTS.
The following are true regarding the zonal anatomy of the prostate, EXCEPT:
There are four zones (central zone, transition zone, peripheral zone and anterior fibromuscular septum). BPH first develops in the periurethral transition zone of the prostate. Nodular hyperplasia is an early phase of the disease, and in the later phase, the size of the nodules increases with the enlargement of glandular nodules. Alpha 1a is the most abundant adrenoreceptor subtype in the prostate. The transition zone comprises 10% of the glandular tissue, whilst the peripheral zone constitutes 65%. The remaining tissue is stroma. Most cancers arise in the peripheral zone.
Which of the following is FALSE regarding the International Prostate Symptom Score?
The IPSS is a validated questionnaire adopted from the AUA symptom score with an additional quality of life score. There are seven questions graded 0–5 and a single quality of life question graded 0–6. LUTS can be categorised into mild (0–7), moderate (8–19) and severe (20–35).
The following therapies for BPH are NOT recommended by NICE (CG97).
The NICE LUTS guidance (May 2010) recommended that if offering surgery for managing voiding LUTS presumed secondary to BPE, do not offer minimally invasive treatments (including transurethral needle ablation [TUNA], transurethral microwave thermotherapy [TUMT], highintensity focused ultrasound [HIFU], transurethral ethanol ablation of the prostate [TEAP] and laser coagulation) as an alternative to TURP, TUVP or HoLEP (Jones et al., 2010).
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