Flashcards in 5/2 Prostate Cancer Deck (58)
sx of prostatitis?
dysuria, frequency, urgency, low back pain
causes of prostatitis?
chronic: bacterial or abacterial (most common)
what is PSA?
serine protease that is responsible for semen liquefaction
why does PSA increase?
- prostate size
- disruption of cellular architecture (prostate cancer, prostatitis, BPH, prostate massage, prostate bx)
it is organ-specific but NOT cancer specific
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
benign prostatic hyperplasia (BPH) - common in what age group
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
∆ btwn microscopic BPH and macroscopic BPH?
Microscopic BPH - histologic evidence of cellular proliferation
Macroscopic BPH - enlargement of the prostate due to microscopic BPH
Symptoms of BPH?
What happens if it's not treated?
- difficulty with starting or stopping the stream of urine
- distension and hypertrophy of the bladder, hydronephrosis, UTI
- chronic obstruction -> bladder dysfunction or spasticity, resulting in poor bladder emptying, urgency, frequency
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
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
What PE would you do on a patient with BPH?
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)
What are some tests that you can run on a patient with BPH?
Purpose of TRUS in BPH?
measure prostate volume
Purpose of Urinalysis in BPH?
r/o UTI, detect hematuria
Purpose of Needle Bx in BPH?
Purpose of Uroflow in BPH?
determine presence of obstruction (= low flow)
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
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
terazosin MoA? indications?
α1 antagnoist -> smooth muscle relaxation to decrease bladder outlet obstruction and improve emptying, flow rate, and symptoms
Used for BPH
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
(5α-reductase inhibitor, 5ARI) = blocks T -> DHT conversion, resulting in decreased prostate size
Used for BPH (also male-pattern baldness..oddly)
- decr. libido, ejaculatory disorder, impotence
- breast enlargement (incr T available for conversion to E)
potential risk for high-risk prostate cancer
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
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
Histologically, what should you see in BPH?
presence of BOTH stromal (basal) + epithelial elements
prostate cancer - common age of occurrence?
where does CaP usually occur? What type is most common?
posterior lobe (peripheral zone)
causes of CaP?
multifactorial - androgens, inflammation, age, race, family Hx
tumor markers of CaP?
PAP (prostatic acid phosphatase)
PSA (usually incr. total with decr. free fraction)