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Clin Med- P > prostate problems and GU cancers > Flashcards

prostate problems and GU cancers Flashcards

1
Q

what is the most common prostate condition?

A

benign prostatic hyperplasia (BPH)

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2
Q

BPH is a major cause of _______ in older men

A

LUTS (lower urinary tract symptoms)

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3
Q

what are the symptoms of BPH? (4)

A

weak urinary stream, post-void dribble, frequent urination, nocturia

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4
Q

prevalence of BPH increases sharply with ____

A

age

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5
Q

for BPH, you can expect prostate volume (PV) to _____ in ___years

A

double in 15 years

BPH tends to progress

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6
Q

what is the AUA -SI ?

A

american urological association symptom index : calculates the chance of Dx being BPH based on cardinal signs, all of which are obstructive signs.

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7
Q

what are the signs that the AUA-SI uses?

A

frequency, incomplete emptying, intermittency, urgency, weak stream, straining, nocturia

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8
Q

there is an increased risk for _____ with BPH. why is this?

A

UTI

why? increased PVR (post-voidal residual volume)/incomplete emptying

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9
Q

txt for BPH? (3)

A
  1. 5-alpha reductase inhibitors (finasteride or dutasteride)
  2. alpha 1–andrenergic blocking drugs: (tamsulosin/Flomax®, terazosin, prazosin)
  3. combo

*Prazosin will lower BP more; other HTN alpha blockers can be used for dual effect (e.g. doxazosin/Cardura®)

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10
Q

how do the 5alpha reductase work?

A

reduce prostate volume:

improve symptoms AND slow disease process

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11
Q

how do the alpha blockers work?

A

relax smooth muscle: improve symptoms

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12
Q

what will lower PSA? making PSA tests harder to interpret (prostate specific antigen)

A

the use of 5 Alpha reductase inhibitor (finasteride, dutasteride)

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13
Q

what is the surgical txt for BPH?

A

TURP: transurethral resection of the prostate

- grinds a tunnel through the prostate

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14
Q

when is surgical txt appropriate for BPH?

A

mostly if there is acute obstruction

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15
Q

what is acute bacterial prostatitis? is it worrisome?

A

Ascending urethral infx or reflux of infected urine– can be severe and life-threatening

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16
Q

what does a rectal exam show for acute bacterial prostatitis? what else is a symptom?

A
  • reveals swollen, “boggy”, very tender, warm prostate

- pelvic pain

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17
Q

txt for acute bacterial prostatitis?

A

4wks abx then maybe TURP or other surgery

18
Q

how does chronic bacterial prostatitis present?

A
  • Frequent and urgent urination, dysuria
  • low back pain, dull aching pain present in the perineum, rectum, or sacrococcygeal region (“like sitting on a golf ball”
19
Q

is acute or chronic bacterial prostatitis more common?

A

chronic

20
Q

PE of chronic bacterial prostatitis?

A

large boggy prostate, less tender than in acute

21
Q

chronic bacterial prostatitis presents with what other infection? what are the organisms?

A

recurrent UTIs
-same strain of pathogenic bacteria in the prostatic fluid and urine; Gram neg enterobacteria (E. coli, Proteus, or Klebsiella) or Pseudomonas

22
Q

Dx of chronic bacterial prostatitis?

A

urine Cx (best after prostatic massage), with Tx based on culture results

23
Q

txt of chronic bacterial prostatitis?

A

Empiric Tx: at least 4-6 wk of FQ or TMP/SMX

24
Q

nonbacterial prostatitis, chronic pelvic pain syndrome (CPPS): what is it?

A

Similar to chronic prostatitis in presentation, but negative cultures, or not responsive to antibiotics

25
Q

txt for CPPS

A

Treatments not highly effective

Alpha blockers, NSAIDs, benzos (muscle relaxer), warm baths, prostatic massage, frequent ejaculation may help

26
Q

what are important considerations for those with CPPS?

A

Psychological considerations: take Pt seriously, validate symptoms, consider pain management, psych

27
Q

what is the most important risk factor for prostate cancer?

A

age

28
Q

BRCA link in ___ % of prostate cancer cases

A

15

29
Q

prostate cancer 2014 review summary: __________ and _____________ are always valuable to use, and to document

A

“Screening Discussion” and “Shared Decision Making” are always valuable to use, and to document

30
Q

prostate cancer 2014 review summary: Screening has the most benefit in ___________ and those with _____________

A

younger men, those with 15+yr life expectancy

31
Q

Much prostate CA is ___________ _______, especially in older men with short life expectancy. “far more men die ___ prostate cancer than ___ prostate cancer”

A

clinically insignificant

-Far more men die with prostate cancer than die of prostate cancer”

32
Q

prostate cancer: Consider what options are acceptable to the patient when? why is this important?

A

BEFORE you do testing!
- often more harm than good is done with screening, prostate size increases with age.. and so does the risk for prostate cancer.

33
Q

The analysis of family medicine recommend what in regards to screening for prostate cancer?

A

against routine performance DRE to screen for prostate cancer in the primary care setting.

34
Q

what is the standard txt for metastatic prostate cancer? what is it often combined with?

A

Androgen Deprivation Therapy (ADT): since prostate CA is extremely androgen-dependent; often combined with radiation therapy

35
Q

painless hematuria and smoking history: what do you think the Dx likely is?

A

bladder cancer

36
Q

unexplained hematuria…

A

MUST be followed up

37
Q

Bladder cancer:______ matters – _____________ is ___%, and low risk. why is this significant?

A
  • depth
  • non-muscle invasive bladder CA (NMIBC) is 75%
  • this cancer recurs often but does not kill
38
Q

txt for bladder cancer

A

intravesicular chemo and BCG for low grade

39
Q

how does BCG work for bladder cancer? (weeds)

A

activates the immune system (for superficial tumors)

40
Q

what is the most common cause of renal cell carcinoma (RCC)?

A

from renal parenchyma

41
Q

symptoms of RCC?

A

Sx: palpable flank mass, pain, hematuria, or incidentally

42
Q

txt for RCC?

A

Tx: nephrectomy, nephron-sparing ablation

Clin Med- P (124 decks)

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