14.4 Prostate

Question 1

What is the function of the secretions of the prostate? What maintains the glands?

Answer 1

• Milky fluid that nourishes the sperms

- Androgens maintain it

Question 2

Acute prostatitis in young adults is usually what? Older adults?

Answer 2

Young = Chlamydia or Gonorrhea

Old = Pseudomonas or E. coli

Question 3

What are the classic s/sx of acute prostatitis?

Answer 3

Tender/boggy prostate with dysuria, fever, and chills

Question 4

What do prostatic secretions show on culturing?

Answer 4

WBCs and bacteria

Question 5

What are the s/sx of chronic prostatitis? What do prostatic secretion cultures show?

Answer 5

• Dysuria with pelvic or LBP

- WBCs on culture, but no bacteria

Question 6

What is BPH?

Answer 6

Hyperplasia of the prostatic stroma and glands

Question 7

Is there an increased risk of CA with BPH?

Answer 7

Nah dawg

Question 8

What is the hormone that is drives to BPH? What cells produce this?

Answer 8

• DHT

- Stromal cells

Question 9

Where does in the prostate does BPH occur?

Answer 9

Periurethral zone of the prostate

Question 10

What are the s/sx of BPH?

Answer 10

• Noctura
• Urine dribbling
• Trouble starting and stopping
• Stream is weak

(NUTS)

Question 11

What are the UA findings of BPH?

Answer 11

Microscopic hematuria

Question 12

Why is there a slight increase in PSA with BPH?

Answer 12

Increase in prostatic glands

Question 13

What are the kidney sequelae of BPH?

Answer 13

Hydronephrosis 2/2 backed up urine

Question 14

What is the MOA of terazosin in the treatment of BPH? Does this have an effect on systemic HTN?

Answer 14

• Alpha-1 antagonist to relax smooth muscle

- Reduces systemic HTN

Question 15

What is the MOA of Tamsulosin in the treatment of BPH? Does this have an effect on systemic HTN?

Answer 15

• Selective alpha-1A antagonist

- No effects on systemic HTN

Question 16

What is the MOA of Leuprolide in the treatment of BPH?

Answer 16

continuous GnRH analog that reduces testosterone

Question 17

What is prostatic adenocarcinoma?

Answer 17

Malignant proliferation of prostatic glands

Question 18

What is the most common cancer in men?

Answer 18

Prostatic adenocarcinoma

Question 19

What are the risk factors for prostatic adenocarcinoma? (Age, race, diet)

Answer 19

-Old
African American ethnicity
-Diet high in sat fat

Question 20

What is the most common location for prostatic adenocarcinoma in the prostate? What does this mean in terms of s/sx?

Answer 20

-Posterior periphery

Since this is far away from the urethra, s/sx do not present until late in the disease course

Question 21

When does prostate screening begin? What is done?

Answer 21

• age 50

- DRE and PSA

Question 22

PSA greater than what level is worrisome at any age?

Answer 22

10 ng/dL

Question 23

Is an increase or decrease in the free PSA in the serum is worrisome for CA? Why?

Answer 23

Decrease in free PSA, since cancer produces bound PSA

Question 24

What is absolutely required to diagnose prostatic cancer?

Answer 24

Bx

Question 25

What are the histological characteristics of prostatic cancer?

Answer 25

Glands that invade the tubules, and contain *dark nucleoli*

Question 26

What is the Gleason grading system of prostatic cancer based on?

Answer 26

Based on architecture, NOT nuclear atypia

Question 27

Where does prostate cancer like to spread? What type of lesion is produced here?

Answer 27

Lumbar spine, with *osteoblastic* mets, thus you get sclerotic lesions

Question 28

How does prostatic cancer often present?

Answer 28

LBP with increased alk phos, PSA, and Prostatic acid phos (PAP)

Question 29

What is the difference between osteoblastic and osteolytic lesions?

Answer 29

Osteoblastic produce sclerotic lesions Osteolytic produces punched out lesions

Question 30

What is the treatment for local prostate cancer?

Answer 30

Cut it out

Question 31

What is the MOA of flutamide?

Answer 31

Androgen receptor inhibitor

Question 32

What is the MOA of leuprolide?

Answer 32

GnRH analog, that is given continuously to inhibit testosterone