5/2 Prostate Cancer Flashcards Preview

x REPRO > 5/2 Prostate Cancer > Flashcards

Flashcards in 5/2 Prostate Cancer Deck (58)
Loading flashcards...
1

sx of prostatitis?

dysuria, frequency, urgency, low back pain

2

causes of prostatitis?

acute: bacteria

chronic: bacterial or abacterial (most common)

3

what is PSA?

serine protease that is responsible for semen liquefaction

4

why does PSA increase?

PSA increases
- age
- prostate size
- disruption of cellular architecture (prostate cancer, prostatitis, BPH, prostate massage, prostate bx)

it is organ-specific but NOT cancer specific

5

3 different ways that PSA can be measured?

kinetics: ∆ over time
density = ratio of PSA to size of prostate
% free = lower % free correlates with higher risk of prostate cancer

6

benign prostatic hyperplasia (BPH) - common in what age group

men >50yo

7

BPH - what is it? where does it often occur?

Hyperplasia of the prostate resulting in a smooth, elastic, firm nodular enlargement

usually of LATERAL + MIDDLE lobes (aka TRANSITION ZONE)

compresses the urethra into a vertical slit

8

∆ btwn microscopic BPH and macroscopic BPH?

Microscopic BPH - histologic evidence of cellular proliferation

Macroscopic BPH - enlargement of the prostate due to microscopic BPH

9

Symptoms of BPH?

What happens if it's not treated?

- LUTS
- nocturia
- difficulty with starting or stopping the stream of urine

Untreated:
- distension and hypertrophy of the bladder, hydronephrosis, UTI
- chronic obstruction -> bladder dysfunction or spasticity, resulting in poor bladder emptying, urgency, frequency
- hematuria

10

how does BPH result in hematuria?

prostate has a lot of veins on its surface; as it grow, the veins are prone to rupture, resulting in blood in the urine

11

What the heck is LUTS?

*LUTS (Lower urinary tract symptoms) complex of voiding symptoms (straining, hesitancy, urgency, frequency) that may or may not be caused by macroscopic BPH

term used when the precise cause of urinary dysfunction is unknown

12

What PE would you do on a patient with BPH?
Justify plz

DRE - est. prostate volume (size ≠ symptom severity)

Focused neurological exam - anal reflex, perianal sensation, gross motor exam neurological dysfunction.

He didn't say, but if this was actually prostate cancer, it can metz to the spinal column and cause neurological compromise (cord compression can cause bladder/bowel incontinence and decr lower extremity sensations/reflexes)

13

What are some tests that you can run on a patient with BPH?

TRUS
Urinalysis
Needle Bx
Uroflow
Urodynamics

14

Purpose of TRUS in BPH?

measure prostate volume

15

Purpose of Urinalysis in BPH?

r/o UTI, detect hematuria

16

Purpose of Needle Bx in BPH?

r/o malignancy

17

Purpose of Uroflow in BPH?

determine presence of obstruction (= low flow)

18

Purpose of urodynamics in BPH?

determine presence of obstruction vs contractility

obstruction = bladder generates high pressure + low flow

impaired contractility = low bladder pressure + low flow

19

in what cases would you recommend watchful waiting for patients with BPH?

What would you recommend patients to do during this period?

when symptoms are not bothersome since risk >> benefits and cost of treatment

recommendations: decr. fluid intake, esp if they have urgency/frequency, avoid diuretics, caffeine, EtOH, timed voiding

20

terazosin MoA? indications?

α1 antagnoist -> smooth muscle relaxation to decrease bladder outlet obstruction and improve emptying, flow rate, and symptoms

Used for BPH

21

tamulosin “Flomax” MoA? indications?

selective α1 antagnoist -> smooth muscle relaxation to decrease bladder outlet obstruction and improve emptying, flow rate, and symptoms

same as terazosin, but with fewer ADRs

Used for BPH

22

Finasteride, Dutasteride

MoA?
Indications?
ADR?

(5α-reductase inhibitor, 5ARI) = blocks T -> DHT conversion, resulting in decreased prostate size

Used for BPH (also male-pattern baldness..oddly)

ADR
- decr. libido, ejaculatory disorder, impotence
- breast enlargement (incr T available for conversion to E)
potential risk for high-risk prostate cancer

23

MoA of Anticholinergic Rx in BPH? What must you monitor if you give this to a patient?

block cholinergic receptors in the bladder that enable contractility (good for men with overactive bladder sx caused by chronic obstruction)

need to monitor PVR (post-void residual) to ensure that these patients don’t develop urinary retention

24

When is surgery indicated for BPH?

What are some of the procedures that you can do?

when BPH is refractory to behavioral + pharmacological Rx


- TURP – scrape out the extra prostate tissue from periurethral regions

- Laser prostatectomy – ablate or vaporize the prostate

- Prostatectomy – usually done for very large prostates

25

Histologically, what should you see in BPH?

presence of BOTH stromal (basal) + epithelial elements

26

prostate cancer - common age of occurrence?

>50

27

where does CaP usually occur? What type is most common?

posterior lobe (peripheral zone)

commonly adenocarcinoma

28

causes of CaP?

multifactorial - androgens, inflammation, age, race, family Hx

29

tumor markers of CaP?

PAP (prostatic acid phosphatase)

PSA (usually incr. total with decr. free fraction)

30

How does CaP progress if it is not treated?

local invasion

metastasis - OsteoBLASTIC metz to bone may develop in late stages, as indicated by lower back pain and incr. in serum ALP and PSA